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Author Topic: Open Debridement and Proximal Z-plasty  (Read 183137 times)

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Offline captainruss

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Re: Open Debridement and Proximal Z-plasty
« Reply #765 on: April 24, 2012, 07:44:15 PM »
Pam,

I will have my OS get me more info on the ON Q pain treatment.

If you contact Medtronics thru their web site or directly they will send you to a doctor who does their implants. 
I would definitely encourage you to try both.  The On Q is not long term, but days with less pain are welcome. 

Russ
80 Shattered patella 5 surg
09  TKR 
09  MUA
09  MUA
09  Knee infected??
10  TKR  Scar Tissue
10  2nd OS  Diagnosis Infection
10  TKR with antibiotic spacer, no joint
4/11  TKR
11  TKR PT
11  TKR
11  TKR  AF diagosis
12/11  HO diagnosed
2012  Intractable Pain
2012  OS split
amputation possible?

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #766 on: September 13, 2012, 07:09:02 AM »
Hi All

I thought I would give an update, since it has been 5 mos , since I last posted. I continue to go to pain management, once a month. I still take a cocktail of meds consisting of: oxycontin, percoset, flexeril, neurontin, clonidine, benedryl, celebrex, lidoderm patches, and compounded pain cream. I get 20 injections to neuromas in my knee, a saphenous nerve block and a tibial nerve block , once a month. Spinal marcaine is used instead of lidocaine , because it lasts longer. I usually get 2-3 days of nerve pain relief to the knee, then a gradual return to full pain over 4-7 days. Sometimes I also get nerve pain relief down the leg and across the top of my foot and toes. I do not get any relief along the lateral side of my foot ( except 1 time), since it is a different nerve branch. The Dr also made a change to the compounding cream I use. He increased the Ketamine and changed the lidocaine, to tetracaine. The cream also has baclofen, cyclobenzaprine (flexeril), diclofenac, gabapentin, mefenac acid and orphenadrine. This change has made the cream a little more effective on the nerve pain. I apply this 3-4 times a day. He feels my only choice at this time , since I've exhausted all other treatments is to do the spinal cord stimulator. He gave me the name of a local neurosurgeon who does work on peripheral nerves, but I haven't decided to see this person. I haven't found anything researching this doctor , that makes me feel he does a lot of peripheral nerve work. I still have not been able to get back to Baltimore to see Dr D. I don't see any plans to travel in the future, because of the bad economy. I've been in pain management for 4 yrs now.

During these past 5 mos, I've been diagnosed with 2 new autoimmune disease processes . I guess I shouldn't be surprised since I already have other inflammatory processes such as, arthrofibrosis, atrial fibrillation and insulin resistance. I was told once you have one autoimmune disease, you usually will get others. I found out I have a chronically inflamed bladder, which I take daily medication for and I have chronic dry eye disease. I don't make any tears. I have to take Restasis eye drops, twice a day and an eye gel at bedtime. The gel is done at bedtime because it makes your eyes very blurry and hopefully will provide lubrication to the eye, for the following day. He also has me taking 1000mg of flax seed oil, for the inflammation. Restasis is cyclosporine for the eyes. Cyclosporine is the medication organ transplant patients take, so they don't reject their new organ. I've seen the Restasis commercials many times and never thought I would be one of those people, to use it. He will recheck the eyes at the end of Oct. If I haven't seen any improvement, the he said he most likely will put in plugs to the lacrimal glands. By doing this, it keeps any tear that I do make, to stay in the eye longer, thus lubricating it, rather than draining out thru the nose, in 1-2 secs.

Scar tissue in the knee has gotten worse, above the patella, around the lateral side and under the patella tendon. It has become more painful, plus very audible when the knee bends or straightens and you can feel it when your hand is placed on the area. My ROM is, flexion 90-100 and extension is 2. The last time I saw Dr N, he said he would scope it out, but I don't know if I want to do that at this point, but it is an option. I've had 19 surgeries to this leg, ever since I severely broke my leg in 2000. I'm also having some issues with the foot (same leg as knee) from the fusion. I feel I was over corrected from the fusions. Before fusions, my ankle was almost completely over medially, now I walk on the lateral side. I had to go to the prothesis dept to get a custom orthotic made. I had to do several adjustments to it and gave it several months to see if it would help, but it did not. I also have an AFO brace, but have to wear it with a tennis shoe only, not to mention.... it is ugly! I also wear a donjoy defiance custom brace for my knee , because of ligament laxity.

Well, that's all for now. All I can say is, nerve pain and AF, are h*ll

Pam
« Last Edit: September 13, 2012, 08:12:24 AM by missmyknee »
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline MyKnee2010

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Re: Open Debridement and Proximal Z-plasty
« Reply #767 on: September 16, 2012, 05:31:21 PM »
Hi Pam,

I've been watching your thread here for the last couple years as I had saphenous nerve problems too. I actually was able to identify the problem due to reading about your experience - so thank you!!!!

Sorry to hear that things have worse! I was kind of hoping no news was good news! I ended up going to a peripheral nerve specialist in Boston as that was the closest one I could find. He operated on one leg last June & the other last September. The first leg had massive damage to the saphenous nerve as well as another smaller nerve so he ended up disconnecting both. In the second leg, he found that the saphenous nerve had grown through the sartorius tendon so each time I moved the nerve rubbed on that tendon - no wonder I was in pain! He did a wonderful job & I haven't had much problems with the nerves since.

I'm still having knee pain so I went to OS#4 this past week. I'll be going for a bone scan in a couple days as he thinks the femur has loosened from the prosthetic. We'll see what happens - I just want to figure out & resolve this as much as possible.

Thanks again for all the information you've posted. It has helped me tremendously & I'm sure many others as well! Take care, & I really hope one day you'll be able to make some progress with the AF & nerve pain!!!

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #768 on: September 19, 2012, 10:43:54 PM »
Hi MyKnee2010

Thank you for such a nice comment. If there is anything positive about all of this, it is knowing I have helped someone thru my experiences. My husband's home office is in Boston, so he flies there periodically. I would be interested to know the name of your surgeon who did the nerve work. As I stated above, I don't see any time I will be able to see my nerve doc, since he does not take ins. What a pitty... I have great ins, no deductable, but can't come up with the cash for a surgery fee up front, then submit bill to ins as out of network reimbursement. I bet the Boston one takes ins. My other choice is a doctor in Arizona who trained under mine, who also takes ins.

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #769 on: November 20, 2012, 05:59:34 PM »
Hi All

I recently saw a Rheumatologist for my Dry Eye disease because I suspected I had Sjogrens ( pronounced: sho-grens) Disease. This disease is an autoimmune disease that attacks your salivary glands and lacrimal (tear) glands. It also causes very dry skin and can affect organs in your body. I had been dealing with dry mouth, throat and skin for 2 yrs. I had a constant hoarse voice too. I thought it was all do to some of the medications I take. It was getting progressively worse , then the dry eyes began. I started researching my symptoms and found it fit the description of Sjogrens. I had some blood tests that came back negative , but the rheumatologist said 70% of the time they come back neg even though the patient has sjogrens. He put me on a prescription mouthwash, prescription toothpaste with a high fluoride, because you are more susceptible to tooth decay and a medication called Salagen (pilocarpine). This med stimulates tear and saliva production. I took the first pill and an hour latter , I proceeded to get nauseated and threw up for 1 1/2 hrs. I also read several warnings of heart arrhythmias ( which I already have) and caution when taking with a med called toprol XL, which I take.  I called Dr next day, told about the N&V and heart/med warnings. They prescribed another med called Evoxac. This med came with same heart warnings. I called DR back with heart concerns and other side affects. It is almost better to have sjogrens with the dry mouth , eyes and other symptoms rather than experience the medicine side affects such as, flushing , profuse sweating etc. I haven't taken the med yet and have an appt with my cardiologist to discuss this with.

So I have another autoimmune disease ( sjogren's) that is classified as a connective tissue disease , just like my  arthrofibrosis and interstitial cystitis . There was a thread on this board, where forum members with Arthrofibrosis , also had other autoimmune diseases. Once you have one autoimmune disease, you have a high probability to get others.

My first autoimmune disease was Arthrofibrosis

Pam
« Last Edit: July 16, 2013, 04:22:56 AM by missmyknee »
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #770 on: January 01, 2013, 10:54:22 PM »
I thought I would post this link. It is Dr Dellon's chapter on, Knee Pain of Neural Origin, in Dr Noyes book, Knee Disorders, Surgery, Rehabilitation and Clinical Outcomes. It provides excellent information on nerve pain in the knee.

www.dellon.com/documents/Knee%20Pain%20Chapter.pdf

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline Jill M

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Re: Open Debridement and Proximal Z-plasty
« Reply #771 on: January 17, 2013, 01:25:20 AM »
Hi Pam! I haven't been on Knee Guru for quite sometime. I read through your posts and it breaks my heart  :'( to hear that you are still having so much pain and worsening symptoms in your knee.
I just want you to know I think of you often and keep you in my prayers.

Jill
8/07 Right subtotal meniscectomy
4/08 Chronic meniscus tear, grade 4 changes
10/08- R distal femoral osteotomy, lateral meniscal transplant, tibia microfracture, osteochondral allograft femur
12/08- AF noted, LOA
2/09- MUA
8/09- extensive LOA, patella baja
1/20/11- TKR

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #772 on: January 17, 2013, 05:32:06 AM »
Hi Jill

Thank you for stopping by to post  :D  I often wondered how you've been and Janet too. I posted on your thread, on what a terrific report you had at your 2 yr post-op check up. I can't believe you have 120 flex!! Keep up the great progress. It's always nice when some of the oldies come back and post their progress 1yr, 2yrs, etc ....down the road.

Best wishes to you !

Pam

4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #773 on: July 03, 2013, 07:14:19 PM »
Hi All

I thought I would post a little update. Not a whole lot has changed since my post dated Sept 13, 2012. I still go to pain management once a month. I get 20 injections of bupivacaine in my knee, to all the neuroma sites. I mark the neuromas with surgical pen, which makes my knee look like it has a bad case of purple measles. We did do something different at my last appt. Part of my nerve pain is due to 2 surgeries to distal tibia fractures . One surgery was done to place 2 plates on the distal tibia and the other surgery was done to remove one of the plates , 9 mos later. I can also feel tightness in the soft tissues, due to scarring from the surgery.  My PM doctor had me bring my xrays so he could see the location of the hardware in my leg. He showed me where one of the screws from a plate on my tibia, pokes thru the bone into my soft tissue, right around where my pain is the worst. He then placed my leg under the fluoroscope  and marked my skin, where it corresponded to the screw. Then he proceeded to inject the area with bupivacaine. This helped quite a lot. It eliminated the intense pain , the burning hornets nest pain. It even helped to eliminate the nerve pain across the top of the foot. This helped augment the tibial nerve block I get. Unfortunately these injections don't last very long, but I hope I can get this new area done every month.

Dr Dellon's policy of not taking any insurance, has pretty much locked me out of seeing him again. Another Dr in his practice, Dr Eric Williams only takes 3 insurance co, none of which are mine. I did find another doctor who trained under him, who is very well credentialed and published. His name is Dr Christopher Maloney and he is located in Tuscon Arizona. He does take insurance and takes mine. My goal is to fly out to see him, hopefully this Fall. Here is his website:

http://www.maloneynerveinstitute.com/nerve-research.html#background

http://maloneynerveinstitute.com/about-nerve-institute.html

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline TooYoungForThis1

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Re: Open Debridement and Proximal Z-plasty
« Reply #774 on: September 28, 2020, 09:59:31 PM »
Pam,

I heard that Dr. Dellon will help you petition your insurance to pay. Have you tried that? Good luck.