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Author Topic: A.C.I performed this morning but I'm struggling  (Read 5604 times)

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Offline Rennschnecke

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Re: A.C.I performed this morning but I'm struggling
« Reply #15 on: November 14, 2010, 02:19:53 AM »
Staples can provide a more secure closure and may withstand swelling better.  The finish could be a neat thin scar although it might also have some zip-like tracks on either side.  I too had dissolvable sutures with steri strips but my leg was swelling loads (clearly not enough icing with hindsight).  Have a scar which is very neat below the patella but widens towards the top.  Also ended up with scarring from the steri-strips shearing the skin.  Don't know if that will ever recovery.  I'm trying some Dermatix to see if it helps.  Not really bothered about the cosmetics I tend to regard my war wounds as a badge of suffering and if anyone at the gym so much as poofs at my attempts I'll scare them with my scars.

Some people are allergic to dissolvable sutures and apparently end up with infections from these, but I haven't a clue whether they would also react to staples.

Use of Clexane (heparin-type drug) is now supposed to be routine practice in the UK.  In Germany they apparently routinely give a two weeks and they think that one week is risky.  Personally I hated the extra injection and kept protesting about it every time they gave it to me.  I felt really smug when they realised that the drug was responsible for my continued bleeding and that my incisions only closed up once they stopped the drug.  I was therefore saved from the whole course but had still had 5 of the things before they finally stopped it.

The UK medical system isn't so good about responding to emails.  A lot of what we experience is down to the individual clinician and what they have set up.  My first surgeon had an excellent secretary who hunted the OS down for every query and got back to me as soon as she could.  If she didn't get back to me it was because she couldn't get hold of the OS. 

In the UK it is very common for OSs to work out of a number of hospitals.  My first OS worked out of 3 hospitals (which is quite small) and has a teaching load.  My current OS works out of 5 clinics, has a teaching load and also has numerous conferences to present at so his secretaries only get to see him once every two weeks if they are lucky.  However, he will respond to some emails.  I get the impression that OSs in the US tend to work more consistently out of one location.

Here this 'squeaky wheel' principle tends to get better results, especially with the NHS.
1/05 Ski accident: 5/05 ACLr LK; 10/06 Scope debridement, trochlear cartilage lesion (Gr4); 12/08 Scope chondroplasty, hematoma; 5 & 6/09 MACI patella & trochlea 'kissing lesions', ROM 0 to 80; 9/09 Scope LOA, IPCS & patella infera; 9/10 Scope AIR & LR.

cdubb

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Re: A.C.I performed this morning but I'm struggling
« Reply #16 on: November 14, 2010, 02:44:06 AM »
Good info on the staples.  All actual incisions I see with the staples in all look pretty  Frankensteinesque...and all healed that I've seen have the marks on the side.  My incision, and I realize it is only 10 days old and will change a lot, is a nice thin line. I do care somewhat about the scar even though I have loads elsewhere on my shoulder and elbow and a c-section scar, but I am a 31 year old female and would prefer to have a decent looking scar if it's going to be 8 cm long and down the center of my knee.   My swelling was kept in check with use of the Gameready post op.  I think I should be paid by the Gameready people because I feel like a advertisement for their product...it's really great though! 

Here in the US, most surgeons do stick with one practice and then they may have privilages at 1 or 2 hospitals or surgery centers. My stage I and stage II were at different facilities.   My OS does have a teaching load also because he is at a teaching hospital.  There are loads of fellows around all the time in clinic and in surgery.  He also does a load of research.  You read his CV and wonder how he has time to actually operate with all the research publications he is involved with, yet he operates 2 days per week, has clinic hours 2 days per week and then I suppose Fridays is when he does all his other stuff.  Surgeons here, especially my Dr., are very reliant on the physician assistants. Mine has 2 full time PA's and they assist in surgery, have their own office hours (first post op is a PA visit) and answer many of the day to day questions that don't need to necessarily go to the Dr.  However, if the Dr. needs to be involved, they bring him in. My example is a spinal headache 2 days post op following my ACI biopsy from the spinal anesthetic. I emailed the PA, had a response in 15 minutes (even though it was 6:30 am) and she also brought my surgeon in with the e-mailing and plan. 

Offline CR_UK

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Re: A.C.I performed this morning but I'm struggling
« Reply #17 on: November 14, 2010, 08:10:05 AM »
Gosh, that sounds awful. I had a similiar experience with appalling nursing 5 weeks ago, although not to this degree at Bushey Spire Hospital (where Stanmore Consultants do their private work) This also involved conflicting info by various physio, nurses and consultant.Also given wrong meds and doubling of meds in error which I fortunately picked up on. I discussed this with the consultant though on day of discharge to clarify things. Unfortunately you did not have that opportunity.
Some very clear errors have occurred in your case with regard to the post op letter you received and its important that you ring up asap to sort this. Its best to phone your consultants secretary and explain that an error has been made. I work in the NHS and see this all the time. It might be that your notes were filed incorrectly in someone else,s file, or had another patients name label on it, the possibilities multiple, but the outcome the same in that anyone else looking after you will be referring to incorrect information.Unfortunately one does'nt always get to see the same person again so its really important that the notes are correct that are available to the person assessing you. Sometimes at follow up consultations notes are not avaialble at all and if you have come from far , would be frustrating for you as well as the clinician. Try and get the letters sent to your GP and always take this along to consultations as this would help the doctor if notes are missing. I had actually poste last night but it would just not submit it. Now I see that we were a few reading your post and responding at a similiar time which explains things. I gave up in the end and went to sleep.Hope you had not too bad a night and can sort things.

Offline summerfun

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Re: A.C.I performed this morning but I'm struggling
« Reply #18 on: November 14, 2010, 12:03:53 PM »
Hi All,

Well i have made it through the night but have not got any further with regards to the clexaine, my out of hours surgery is saying without proper discharge papers and knowing what dose of clexaine i need they cannot prescribe it even though they will only do a one off dose for today until my own GP can see me tomorrow. They have asked me to ring Stanmore and see if i can get some further information out of them but Stanmore only take calls after 12 so am about to ring and see if i can get some answers so will keep everyone informed, as for my knee well it feels like its on fire and extremly painful but thats to be expected.

Right now to phone Stanmore .....

Offline summerfun

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Re: A.C.I performed this morning but I'm struggling
« Reply #19 on: November 14, 2010, 12:48:55 PM »
Ok i have spoken to someone at Stanmore who has said my discharge meds are sitting their still in the cupboard, regarding Clexaine they have said they dont give it to patients after this sort of op, i explained i had one given to me on the day of surgery and that there were 3 more in my medical bag but i was not given them but he said i defiantly did not need them so local gp service has said that they must know what there talking about and if they say i dont need it then i dont, so i will not be getting any. I also asked about wether i am meant to be doing any sort of exercise while i am sitting here and he said no, but that if i get any pain or my knee swells then i must see my gp who will need to ring them and get advise from the consultant, well my knee is huge and extremly painful but i am sure this is normal and have resigned myself to the fact that i am not going to get anywhere until i get to speak to Mr Carringtons secretary tomorrow.
One thing i did forget to mention yesterday that i noticed after i came round from surgery is that my left arm has bruising marks where the blood pressure cuff was and below that and right over my hand is a nasty looking red rash but its not a rash, i think they must of put the cuff on to tight and it has bruised all my arm, i will try and upload a picture of it later.

I just wish i knew what i am doing is right and that by doing nothing i am not doing anything wrong if that makes sense, but only some answers tomorrow will tell me that, hopefully, Emma

Offline Rennschnecke

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Re: A.C.I performed this morning but I'm struggling
« Reply #20 on: November 14, 2010, 12:58:22 PM »
This is all so frustrating isn't it and all at a time when you just don't need it.

If you knee is hurting do try icing it.  It'll be worthwhile investing in an Aircast unit if you don't have one already.  It allows you to ice the knee virtually continually and cdubb in the US has used her equivalent so well she's doing really well way ahead of the curve.

Good luck with tackling Mr Carrington's secretary tomorrow.  I guess you'll only get peace of mind once you've got an answer from there.
1/05 Ski accident: 5/05 ACLr LK; 10/06 Scope debridement, trochlear cartilage lesion (Gr4); 12/08 Scope chondroplasty, hematoma; 5 & 6/09 MACI patella & trochlea 'kissing lesions', ROM 0 to 80; 9/09 Scope LOA, IPCS & patella infera; 9/10 Scope AIR & LR.

cdubb

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Re: A.C.I performed this morning but I'm struggling
« Reply #21 on: November 14, 2010, 05:12:15 PM »
Summerfun...highly, highly, highly recommend the air cast if it is like the Gameready!!  It takes away the burning/hot sensation (which is normal) and provides pain relief beyond what my Oxy and Norco do (don't get me wrong...I like those too), but the Gameready reduced dependency on those and just really helped me so much.  I'm getting ready to send it back on Monday because I'm paying $25/day(unsure what that equates to in UK currency) for it and I think I am at a point I can switch to normal icepacks, but if you can get an aircast, do it ASAP...the first few days are critical!

Offline summerfun

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Re: A.C.I performed this morning but I'm struggling
« Reply #22 on: November 14, 2010, 07:04:57 PM »
Hi all,

I wish i could get the aircast but i simply cannot afford it, i have been given the telephone number of the red cross today who loan some equipment so will ring tomorrow and see if they can help, i doubt it but you never know if you dont ask. I will feel alot better i think tomorrow when i hopefully get some answers to my many growing questions, today was my poor husbands birthday and all he has done is help me on and off the toilet and put up with me crying in pain and confusion.

I have tried to take pictures of my arm with the rash/bruising that is all over it, i am unsure what it is exactly but it is the least of my worries, i just thought i would show you guys.

One thing i am curious over is what dressing you came home with on, as you know they tried to put a tubigrip on mine but as i screamed in pain they shoved the old bandage back on but its disintergrating and im not sure if i should put something else on or wait and see tomorrow.

I hope everybody else is recovering well and anyone who has a procedure approaching please do not be put off by whats happened to me as i am one of those that attracts bad luck lol, Emma

Offline Rennschnecke

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Re: A.C.I performed this morning but I'm struggling
« Reply #23 on: November 14, 2010, 08:01:36 PM »
Hi Emma

I was discharged with a Tegaderm dressing on it's a light padded dressing which is waterproof.  No bandage as it interferes with rehab exercises.

If you can't buy an Aircast consider getting an ActiveWrap or a Dura Soft ice wrap for the knee.  Active Wrap comes with a gel pack which I've found to be one of the best ever stays cold for a long time (more than an hour).  The Durasoft has been rated by others and I think it goes around the whole knee so you can ice behind as well as on the front.

If you are using ice packs don't exceed 30 minutes as you can get frost bite.  Ideally you'd be icing 20 m on 40 m off, but it is hard work which is why the Aircast is so good.

Hope you get all your questions answered tomorrow!
1/05 Ski accident: 5/05 ACLr LK; 10/06 Scope debridement, trochlear cartilage lesion (Gr4); 12/08 Scope chondroplasty, hematoma; 5 & 6/09 MACI patella & trochlea 'kissing lesions', ROM 0 to 80; 9/09 Scope LOA, IPCS & patella infera; 9/10 Scope AIR & LR.

cdubb

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Re: A.C.I performed this morning but I'm struggling
« Reply #24 on: November 14, 2010, 08:36:07 PM »
I had 4 x 4's and gauze wrap, but I was permitted to take that off on day 2 post op. Then it was just my steri-strips. I had to keep that dry, so I had pre-purchased the Tegederm that Renn referenced and applied myself to make showering easier.  Not sure about UK, but here I purchased my Tegederm up at a local pharmacy.

As for icing, I have some Durasoft packs that I was discharged with for my Stage 1 left knee in August and for my right knee scope that was done the same day as my left ACI/AMZ.  It doesn't ice the back of the knee, but it has velcro tabs that wrap around the back to hold it on and it covers a good area.  It comes with 2 packs, so one can be freezing while one is being used.  I have 2 wraps and 4 packs now. They work well, so if you can get something like that I'd recommend it.  It's easier than having to deal with actual ice.  It kind of floors me that you weren't given anything at all icing wise (either an icing system or reusable pack/wrap) at discharge? 

I am really sorry that you are having to go through this.

Offline Rennschnecke

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Re: A.C.I performed this morning but I'm struggling
« Reply #25 on: November 14, 2010, 08:43:30 PM »
In the UK the NHS don't routinely discharge ortho patients with any kind of icing system.  In fact, on one occasion I made a big fuss about having some ice whilst still on the ward.  Apparently they didn't have a budget for ice! (Ha, ha!)

Can you imagine a specialist ortho hospital with no ice?  ::)
1/05 Ski accident: 5/05 ACLr LK; 10/06 Scope debridement, trochlear cartilage lesion (Gr4); 12/08 Scope chondroplasty, hematoma; 5 & 6/09 MACI patella & trochlea 'kissing lesions', ROM 0 to 80; 9/09 Scope LOA, IPCS & patella infera; 9/10 Scope AIR & LR.

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Re: A.C.I performed this morning but I'm struggling
« Reply #26 on: November 14, 2010, 09:14:53 PM »
No budget for ice ???.  Kat Walk in Australia had a similar experience and had to practically beg for ice repeatedly in the hospital after her TT.  Ice is such a simple modality and so effective!  Seems a bid absurd to not ensure that such a simple tool that is so essential toward a comfortable recovery is not routinely supplied?  If an icing machine is too expensive, then at a bare minimum reusable ice pack/wrap!  Quite unfortunate....

Offline CR_UK

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Re: A.C.I performed this morning but I'm struggling
« Reply #27 on: November 15, 2010, 02:02:29 PM »
Hi Summerfun
Hope you are able to sort some things today.
I also had a tegaderm + pad which was great and waterproof. In fact they had me in the hydrotherapy pool 36 hours post op at Bushey Spires. Showering works well with it.
Have you considered looking on ebay for an aircast icing system? That might be a cheaper option?
As regards your rash on your arm, photo quality except for first not that good for me to give you a diagnosis (dermatology is my speciality) It looks a bit eczematous (is it itchy and what is its distribution) If it is I would suggest a mild steroid cream to try (you can buy Eumovate over the counter) and would do no harm in trying.(unless you are allergic) You may have reacted to something applied to your arm. If it does'nt respond ask your GP.

Offline summerfun

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Re: A.C.I performed this morning but I'm struggling
« Reply #28 on: November 17, 2010, 01:40:57 PM »
Hi Guys,

Im sorry i have not posted for a couple of days but apart from telling you its really hurting, being woken up at night with it etc which i know you have all been through i had nothing to report due to Stanmore's lack of reponse  >:(

On Monday morning i telephoned Mr Carrington's secretary at 9am prompt and gave her the basic version of what had happened to me and told her that i wanted a to speak to either Mr Carrington or Mr Mallack who had performed my operation and i wanted the call back before 2pm Monday afternoon so that if as i feared i did not get a call back it left me enough time to call back and really go to town on them. Well as my hunch was right i was back on the phone just after 2pm and again speaking to the secreatry who said that she had not managed to locate my notes as they had gone somewhere to be colour-coded before coming back??? and without the notes they would not be able to speak to me which i told her in no uncertain way that i was not going to wait another day, with that she said she would get someone from physio to speak to me now to answer some of my more urgent questions while she tracked down the consultants and see who could speak to me. After being on hold for what seemed a lifetime a i got to speak to a physio lady who took brief details of what had gone on and she then said she would ring me back as she was currently teaching, so somewhat nervously i agreed to her to ring me back in half an hour and for once true to her word she did. Luckily she turned out to be the physio who had done my referral that morning to my local physio department so at least she had some brief knowledge of me and my operation, i went through everything that i now had listed on my pad so that i forgot nothing and there were differences in to what she had advised my physios, her advice had been based on Stanmore's typical post op protocol which was 2 wks NWB, then brace put at 45 degrees and then i can start PWB and 2 wks after that brace at 90 degrees and continuing strengthening excercises but when i explained that i was told 6 wks NWB this confused her, i gave her the name of the physio person that had told me this on ward and explained that she would have no choice but to look into my case in more detail and speak to Mr Mallack directly. In regard to what had happened on Ward 4, my treatment, medication, dressing and overall care or lack of it, she again would need time to look into it as she was not qualified to give advice on these and had i spoke to a nurse regarding these issues. I again explained i had telephoned Duke of Gloucester ward to get some advice as this was the ward i should of gone on and hoped they would be better qualified to advise me but that they had said they would not help as i was not on their ward and although i had phoned ward 4 on sunday, their response left me feeling even more unsure. It was agreed then that she would telephone me the next day, i.e Tuesday to give me the correct physio instructions and that she would make sure either Mr Carrington, Mr Mallack or the senior registrar would also telephone me to answer my medical questions and tell them exactly what had happened.
On tuesday as promised she did ring me back and told me that she had spoken to Mr Mallack and that what she had told me the day before was correct, that i should be 2wks NWB then be PWB once i had had my first appointment with my local physio, so i said well there is a big difference between 2wks and 6wks especially with my joint condition making it even more difficult and hoped she would be speaking to the physio who had seen me on ward. I also asked her wether i should have the two splints and was it right that i was putting the other one on at night and again the answer was no and again she would be dealing with these issues. I was then asked if i felt happier and i told her i did from a physio side of things but that i still had unanswered questions from a medical side, she then said had i not heard from Mr carrington or his secreatry and i said no although she had promised to ring me before now, so with that she asked me to hold the line and she would see if she could get someone to speak to me then and there. As it was she could not but said she would make sure that someone rung me back, well 45 mins later i received a call from Mr Mallack who was in theatre! I went through everything that had happened again and he broke them down into seperate issues, first he aked if i had seen his senoir registrar on the afternoon of my operation, no i said so then he said did i go to Duke of Gloucester after theatre, again no, i told him i went to ward 4. He said they dont ever send their patients to ward 4 not because they are bad nurses but because they have no experince in knee's and hip surgery, he then said everything was coming back to him and asked me to confirm that i had my op friday morning and when i was discharged so i told him and he said that was to soon due to my surgery. I wont go on to much as i realised i have taken up way to much of your time reading this already but the bottom line is my defect was bigger than expected hence why i should of been in longer and as it is i am NWB for the full 6wks, so now all has been explained i do feel better, sorry to of bored you Emma.

Offline CR_UK

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Re: A.C.I performed this morning but I'm struggling
« Reply #29 on: November 17, 2010, 04:23:07 PM »
Hi Emma
Good to hear you have it sorted. Being persistent like you were is the only way, unfortunately. Make sure you get copies of the correspondence (ask Mr Carrington's secretary) as she types it. Alternately you could ask your GP. Luckily that physio you spoke too went to a lot of trouble looking into it for you. Make a note of her name for any future physio queries you may have.
Good luck with your recovery and hope you feel better soon. :)