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Author Topic: Kathy's Pre-op Diary  (Read 25292 times)

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Offline kathat

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Kathy's Pre-op Diary
« on: May 13, 2008, 05:11:17 AM »
Well, it is now official - I am booked in for a distal patellar tendon transfer (aka TTT) on the 18th of June. This is how my day has panned out....

PT appointment first. PT checked out all my crepitus and ROM and did some massage. Expressed his hope that my OS would do something, as the exercises hadn't worked. Told me he'd like to watch my surgery if I have any, as he'd love to see what's in my knee (though it turns out that it's not on a good day for him)!!! Discharged me from PT with instructions to come back and let him know what the OS decides.

OS appointment next. OS not real happy about how things are going. Talks about surgery but not real optimistic about it  :P Then tells me to make a decision!! I asked lots of questions. I find out that he has an aggressive post op protocol. Weight bearing straight away, only with a splint if muscle strength not good (my PT contradicted him and told me I WOULD have a splint), and crutches for support if needed (I think I will need!). I am to do as much as humanly possible to build up quad strength and get the right muscle patterning - ie LOTS of SLRs. He said that going into the surgery with poor muscle strength isn't a good start and is more likely to result in the surgery not being successful. BUT I can't build up muscle strength with such irritable knees. He's really not happy with the situation, but there isn't anything else he can try until it comes time for partial replacement/resurfacing, and if things get left for much longer then they may get worse still. And, as he said "it may well work really well, we just don't know". So if this doesn't work, it's tough luck and it'll be medical management only for some time. I will stay under the same OS and he will monitor me regularly, but this is it as far as surgery goes for quite some time. He doesn't expect to do the same surgery on my left knee, as it's slowly plodding along without giving too much grief. And I found out that my MFC defect is in a spot where it's not likely to cause me too many problems. Phew!

Then it was time to make the surgery booking. Decided to go for mid June to fit in with other things (I have a first aid course on the 14/15th June that I wanted to be able to get to, and hubby is away on the 6/7th June). They had an opening for the 18th so I took it, as it is after all of my daughter's orthodontic appointments, and it's roughly two weeks before the school holidays, so I don't have to worry about imposing on friends to take the kids to school and home for too long. It suits me very well. I got told I have to be screened for MRSA (golden staph) due to my job as a nurse, so I then went off to the place where I could get that done (nose, groin and armpit swabs get taken to test for MRSA). I don't know what they'll do if I carry it, but I guess I'll have to shower in some fancy antibacterial soap prior to surgery at the very least.

After that it was time to come home and do battle with my washing machine that has picked today of all days to break down. At least it's still under warranty!

So, there it is. Now all I have to do is wait. Blah!! I hate waiting! At least I now have a time frame to work within. Any suggestions on what to do in preparation will be greatfully received.

Cheers,

Kathy

Offline chaos

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Re: Kathy's Pre-op Diary
« Reply #1 on: May 13, 2008, 05:17:22 AM »
ahhh kath sorry you need more surgery but am going to be positive and assume this is going to help you put an  end to your knee surgery.  i am always here if you need a good cry or to scream in frustrion.  thetime will pass very quickly so i suggest lots of bubble baths.  i haven't been in my poor bathbut in weeks.  i so want to paint my toes but that isn't going to happen in the very near future. oh well, i will get there when i get there.  pretty toes are overrated.

how are you feeeling about all of this??
beauty always comes from within.  the outside doesn't matter.

Offline kathat

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Re: Kathy's Pre-op Diary
« Reply #2 on: May 13, 2008, 05:53:43 AM »
Hi Allison,

Thanks for the words of encouragement. I live for my bubble baths, and I plan to have as many as I can while I am still able to, as baths aren't the best thing post-op! I find that a hot bath is one of the best things for soothing my knees when they hate me. Tonight before work will be a good night for a bath, as the kids will be out with hubby and my knees are complaining about the PT appointment. Or I might have a sleep instead, as I didn't sleep well last night (I wonder why?!!).

I must admit that I was disappointed by my OS's lack of optimism about the surgery. He really didn't know if it would be a good thing or not. I suppose it's good he didn't give me false hope, but I had hoped for something with a better chance of success. And after only two surgeries I will have exhausted all options at this point in time, which is not quite what I had hoped for either. Not that I want lots of surgery, but I feel like I am running out of options fast. God, I hope this surgery helps, even a bit!

Beda - I forgot to answer your question on your thread, so I'll give you the answer now. I go to a private centre called Sportsmed. They have their own hospital and day surgery unit attached, so my PT can come to visit me after surgery  ;) They have about ten to twelve orthopaedic surgeons, with varying specialities (mine is the most senior and the most qualified OS). They also have GPs, PTs, a gym and a few other services as well.

I hope you are all having good knee days (or better than usual knee days!). Tkae care.

Kathy

Offline tanyap

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Re: Kathy's Pre-op Diary
« Reply #3 on: May 13, 2008, 09:21:50 AM »
Hi Kathy,
Wow - a TTT for you!
I understand what you mean about your OS not being enthusiastic - but sometimes they are like that so as NOT to give false hope, he wouldnt be doing a major surgery if he didnt think there was SOME chance of it working out ok right? These guys do not do surgeries so they can be failures, I think he just wants you to be aware that there is risk involved and that that risk is that it may not work out 100%. Which is a responsible attitude for him to take because itd be awful if he was totally gung ho about it and not telling you the truth.

Can you do SLRs without pain Kathy? What else can you do without pain? I think as 'pre op prep' figure out any exercises that dont cause too much pain and do them as much as you can. Try not to worry about building bulk up, the reason you havent been able to is the reason WHY you need surgery, but if you can keep the messages going from the brain to the muscles you will have a good chane afterwards to wake them back up again.

How do you feel about it? I know you trust your OS but would you consider going for a second opinion to see if a different OS would seem more enthusiastic?

Kathy it COULD go really well and thats what youre aiming for - youve said yourself, there are no other options, but you cannot continue as you are - something has to change.
xxx
1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline kathat

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Re: Kathy's Pre-op Diary
« Reply #4 on: May 13, 2008, 10:59:31 AM »
Hi Tanya,

SLRs are really the only exercise I can do without pain. Actually, it's not really pain, but severe aching AFTER the exercise that is the problem, though some movements cause me lots of discomfort and some brief pain as my cartilage catches. I am ready to strangle my knees at the moment after today's appointments, which shows how bad things are, because my PT got me to do two squats with both legs, and one single leg squat on each leg, as well as one short arc quad per leg. And that's it! It has really flared things up something shocking. Anything that involves bending the knees seems to set them off sooner or later. Even walking. My OS says I still have some tracking issues, which is why I am still having pain and why he wants to do the TTT. He showed me how my kneecap shoots off laterally as I flex the knee, which apparently it shouldn't do (I don't really look at other people's knees to compare).

So, I agree in doing the SLRs and plan to do lots. My PT mentioned about keeping the muscle pathways alert too, like you did, so I will persist even though they don't seem to do much.

I realise that surgeons don't like to be too optimistic, but when mine shook his head and growled in frustration it sort of got me worried! I have vaguely contemplated getting a second opinion, but I am with one of the best OSs at the moment and don't really think I'd trust my knees to anyone else. Even though my LRs didn't give me pain relief, they corrected the tilt beautifully - my cartilage was just too chewed up for the release in pressure from the LR to do much in the way of improving the pain. And that is pretty much what I am worried about with this next surgery. I have researched plenty and can't really see any other procedures that I feel I should have been offered and haven't, and he has good explanations and reasoning behind what he does (when I bother to ask!). I think he honestly doesn't know if it will help, as there are too many variables with my knees. I trust him to try his best and if it doesn't work then at least I know I have tried. He really doesn't believe I'll end up worse, short of surgical complications, so I have to give it a go.

I am just hoping really hard that it works!

Kathy

Offline tanyap

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Re: Kathy's Pre-op Diary
« Reply #5 on: May 13, 2008, 11:56:54 AM »
Kathy,
I once went to see the TOP knee surgeon in Ireland and he had one great piece of advice for me. He said that as everything I did seemed to aggravate my pain I had to sneak resistance onto my quads and one clever way of doing it was just by sitting watching tv with my leg extended and a weight on the end of it - not bending, not lifting, just sitting. That will cause tension in the quads even though it feels like youre doing nothing, youre fighting gravity.

You can also try some e-stim, again just so's youre not putting any weight through a bent knee. Just be careful you dont turn the intensity up too high cos that always used to make me ache.

Just do what you can kathy - you can only do whats possible for you without having too much pain.

Im REALLY hoping it works good for you too.

Did you ask him how long you are likely to have relief for if it works out good?

xxx



1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Silkncardcrafts

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Re: Kathy's Pre-op Diary
« Reply #6 on: May 13, 2008, 12:11:58 PM »
Hi Kathy,

Sorry to hear you are up for more surgery and that your OS wasn't that optimistic.

I would definitely be seeking another opinion. Don't think you OS really has the best understanding of patella problems. The best in Australia is probably mine in Melbourne. Let me know if you want his details. I don't think it will be the end of the road if this surgery doesn't work.

Have you thought about doing clinical pilates ? It is a great way to strengthen up your quads and body in general. I have been limited in the exercise I can do and been one of the few things that I can do pain free.

Good luck !  ;)
11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty

Offline kathat

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Re: Kathy's Pre-op Diary
« Reply #7 on: May 13, 2008, 12:21:33 PM »
Bugger! I knew there was something I forgot to ask!! I will be happy if it works full stop at this stage! I can guess it will be around the 5-10 year mark, though probably on the lower end due to the cartilage damage that has already occurred. I would be happy with improvement that is good enough for long enough for me to build up some muscle strength, so that I have some joint support again. That seems to be what works the best in keeping arthritis pain at bay. Once there is good muscle strength and endurance then it's easy(ish) to maintain things and the aching is less.

Thanks for the tip for the quad work. It's a good exercise to try.

Kirsty - You can PM me your OS details if you like. It would be worth keeping on hand just in case. My issues aren't just tracking though - I have chewed through lots of my cartilage and that's having a huge impact on my knees. The tracking isn't the best but it's the cartilage damage that is causing all my grief. So even if my tracking is corrected with this surgery I still may never get relief from the aching. The surgery isn't the end of the road completely, but it's the end of the road for quite some time. If it fails then I'll think about a second opinion, just to be certain, but I'm not letting anyone else near my knees just yet.

Oh crap, I'm going to be late for work if I don't hurry up!!! To be continued.....

Hi-ho, hi-ho, it's off to work I go.......

Goodnight  ;)

Kathy

Offline JoniF

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Re: Kathy's Pre-op Diary
« Reply #8 on: May 13, 2008, 02:31:02 PM »
Hi Kathy,

I'm sorry to hear that you require more surgery.  I am glad at least that you have a plan in place, I know you were going back and forth for awhile.  Hopefully this will fix at least some of your issues.  Will you have have to stay overnight?  When I had mine back in 1997 I was in for 3 nights and was not allowed to weight bear for 6 weeks.  Things have changed soo much since then though.  After reading everyone's posts regarding TTTs and everyone's dr.'s protocol's are soo different.  Please no that if you need anything, I am here for you.

Take care,
Joni
1989 Lateral Release, debridement, and arthroscopic surgery - lk
1996 TTT, Elmslie-trillat procedure, lateral release and debridement - lk
1997 Debridement and hardware removal - lk
2006 Lateral Release, 2 meniscus tears repaired, & acl repair - lk
2008 Sev Patella Effusion - rt knee

Offline lb573

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Re: Kathy's Pre-op Diary
« Reply #9 on: May 13, 2008, 08:56:22 PM »
Hi Kathy,

So it is now your turn to join the TTT club! I have to admit, it was not a club that i wanted to join, but now that i have, there are no regrets (well with the L knee anyway...it is way to soon to judge the R knee). I have to second with what has been already said as far as relaxing and enjoying those things that you may not be able to do post-op for awhile. Your post-op protocol sounds very agressive but in a good way...just a bit more agressive than my OS was with my L knee (if only things were the same with the R...). Prior to my TTT/LR's, i was told by my OS and PT that i could more or less do what i wanted and that some pain was totally okay. I know that the stronger your leg is going into surgery the better recovery should be, so definately do what you can to build up those quads...easier said than done though! Best of luck with everything!!

Leah
27 yo RN
L Knee:
07/'01 - scope
01/'02 - scope
12/'03 - LR
07/28/2006 - TTT/LR/Patellar Debridement
07/11/2007 - Screw Removal
R Knee:
07/06/2007 - Patellar dislocation
04/10/2008 - TTT/LR
06/11/2008 - MCL tear, Bone Bruise
09/29/2009 - Medial plication/reconstruction/debridement

Offline kathat

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Re: Kathy's Pre-op Diary
« Reply #10 on: May 14, 2008, 12:49:35 AM »
Hi All,

Thanks for the support guys! It's much appreciated.

Joni - I will be in overnight only, mostly to ensure pain control is established and sort out any mobility issues. I am to be admitted at 10am on the 18th and be discharged by 10am on the following day. I am trying to decide who I want to drop me off and pick me up. Hubby's work gave him grief last time he took the day off for my surgery, so I don't think I'll ask him to go through that again. I have several friends who'd be willing to help out, and so would my parents or my in-laws.

Leah - I am cautious about the aggressive protocol, but it certainly seems to work, and my PT is determined to get me mobile and out of the brace ASAP to prevent wasting quads causing ongoing issues, which is probably the biggest risk I face aside from surgical complications. The centre I go to is internationally known in the sports world for getting people back into their sport within much less time than with "traditional" rehab protocols. Their motto is "keeping active people active" or something similar.

How ironic this is - when I was given my forms to get my MRSA screen done I said to my OS's PA that I was glad we didn't have any VRE (Vancomycin resistant enterococcus) patients on the ward, as it's an even harder to treat infection than MRSA. And guess what we got on the ward yesterday?!! Yep! A patient with VRE  :( Thankfully they are allocated a nurse who only looks after the VRE patients, so I don't have to go too close, and it isn't likely to cause disease, even in a person that is colonised by it, unless they are immunosuppressed or similar.

Actually, I just remembered something. My OS asked me if I had tried taping. I think he was desparate for me to find some way of relieving the aching enough to improve my muscle strength, as the surgery will be more likely to have a better outcome if I can increase quad strength first. I tried taping years ago and it helped the pain, but I am allergic to tape and it got so bad that I couldn't continue with it (that's what got him groaning in frustration). I tried it for a bit before seeing my OS for the first time, and it helped in some ways and made things worse in others, and I was driven up the wall with the itching caused by the tape. Maybe I should try it again and see what happens, just so I can report back to my OS. Any thoughts?

Anyway, it's off to bed for me, as I am working again tonight. Goodnight.

Kathy  :D

Offline KW

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Re: Kathy's Pre-op Diary
« Reply #11 on: May 14, 2008, 01:05:57 AM »
Kathy,  You really should try taping again. They make tape for sensitive skin that should not bother you as much. It is said that taping mimics the results of the TTT.  If if helps great...If if causes more pain or other issues I suggest you discuss these with you OS prior to your surgery. 

As for the aggressive PO Protocol...My 1st TTT had a VERY agressive Protocol.  I was never on crutches...only took pain meds for 2 or 3 days...back at work at 11 days PO (desk job) and I have a 1.5 hour commute.  I did better with the aggressive protocol then I did with the more conservative protocol of my 2nd and the snails pace I am on for my 3rd.  The other thought is that the sooner you are WB the sooner and faster the bone begins to knit.

Good luck,
Karen
Right Knee
2000 - 2002 - Scope,LR,TTT,Unscrewed
01-10-12 - PFJR

Left Knee
04/07 TTT/LR
08/07 Bone Grth Stim
10/07 Loose/Bent Screw
1/08 Unscrewed/MRI~NON-UNION
02/19/08 Lt  TTT Revision W/Graft
12/09/08 Scope
05/15/09 Scope
09/04/09 PFJR/Unscrewed

Offline Beda

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Re: Kathy's Pre-op Diary
« Reply #12 on: May 14, 2008, 08:01:08 AM »
Kathy - glad to hear you got through your appointment, sorry to hear the OS wasnt more convincing. But, as hes a top sports OS surely he knows what hes doing?? If you have any doubt in your mind whatsoever I'd certainly get a 2nd opinion if I were you!
Thats incredible fast your going to be in the hospital for about 24 hours!! i know they throw you out early these days, but 24 hrs. for a TTT sounds to me like its VERY fast. But you know what to expect, being youself 'in the business' so to speak! How long are you going to be off work?? If you have FWB immediatly, surely your going to be using some crutches for the first bit of time post op. I too will be FWB immediatly after my surgery, but the surgeon said I'd have to use crutches and I'd have to learn to walk all over again as the new leg is going to feel pretty strange. I hope for you that this op is the answer for your problems, and that it cures your pains, if it wins you 8-10 years before further surgery then is well worth it. i do HOPE for you that you DONT have to have further surgery after this if the op is a success, but time will tell. It must be a real killer being a nurse when you have to be on your feet so much. have you ever had a pedometer to work out how many miles you walk in a day? It must be a lot. When I was a chef sometimes I'd walk up to 4 miles each day, just running around in an industrial kitchen. Then theres a lot of just standing, like standing over a stove stirring etc.
kathy, I wish you all the best and will help you countdown to your op!!
Love Beda XX
'79 trauma v.knee
'81surgery patella lux.
'84 osteochondritis dissecans
'86 osteotomy
until now 16 knee surgerys ink. 6 failed tkr. pretty much exhausted all areas and types of surgical proceedures for knees
all TKR's loosened & failed
2008 wait for Final arthrodesis
constant pain

Offline tanyap

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Re: Kathy's Pre-op Diary
« Reply #13 on: May 14, 2008, 09:26:17 AM »
Hi Kathy,
Try the taping - get the sensitive skin tape like karen suggests - its definitely worth a try. If you suffer an allergic reaction at least you can tell him you tried it?

I like the sounds of an aggressive protocol - it will win such gains in the long run - even though you will no doubt be cursing it initially :) But it will be fine!!

I really hope this surgery gains you a long number of years - thats the aim, same as me, I know some day a TKR probably awaits but its putting it off as long as possible we need.
xx
1986 - recurrent dislocations of right patella began
1988 - Modified Hauser Procedure
1991 - dislocations started again
2005 to 2007 - 150 dislocations in 2 years - OUCH!!!
June 2007 - new OS, new physio
Oct 2007 - VMO woke up
Mar 2008 - big quads, still dislocating
Apr 2008 - next OS app

Offline Silkncardcrafts

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Re: Kathy's Pre-op Diary
« Reply #14 on: May 14, 2008, 10:29:33 AM »
Hi Kathy,

My OS doesn't just specialise in patella problems. He also specialises in arthritis and knee reconstructions. My knee surgeon gets referred all the difficult cases, mine of which is one.

I am about to PM you his details.

Good luck !!  ;)

11/1996 - RK LR
07/1997 - LK LR
11/1998 - LK MPFL Reco
12/2005 - RK LR Repair
07/2006 - LK MPFL Repair
11/2006 - LK LR Repair
22/05/08 - LK Trochleoplasty
11/02/10 - RK Trochleoplasty
07/03/11 - RK Chrondroplasty