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Author Topic: A.C.I performed this morning but I'm struggling  (Read 5834 times)

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Offline summerfun

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A.C.I performed this morning but I'm struggling
« on: November 12, 2010, 06:10:24 PM »
Hi Guys, I had my second stage A.C.I this morning 12.11.10 and went down at 8am so ver quick, I came round in recovery at 11.15 and was moved to a ward at 12. The only problem was I had to go onto Coleman unit at 7am and was told I would then go onto Duke of Glocester ward from theatre only I got put on ward 4 and noone told my poor husband or son until after 1 so they were really worried and I was worried they had left lol.  I got onto the ward at about 12 and by 1.30 I thought I was going to cut my leg off, the pain was and had been getting steadily worse and the nurse gave me a paracetamol needless to say this done nothing by which point I also had to endure the humility of using the bed pan and due to me haing EDS I could not support my body weight and as the nurse had gone I had to sit in pan for 10 mins before the buzzer was answered. By now I have really had enough and told my husband to demand my discharge papers as I could do a better job at home, I was really upset as when I had stage 1 done they were brilliant on Coleman but this ward seems to deal more with spinal so it's seems a knee is nothing. To top it off the staff had a meeting which they said was a 1/2nd one but in fact went on for 1hr 45 mins to which once again I got left on bed pan so by the time they came out I was ready to go and told them in no uncertain way, suddenly physio are called to see me, doctors called to amend my prescription and I'm told I can hopefully go home tomorrow.

I realise mine does not sound great but I'm hopeful that this is a rare occurrence here and am convinced it's due to being put on any old ward who had a bed, I just hope I can control the pain as my medications are all at home, oh and I've just had a injection into my stomach but not sure what this is for?

Hope everybody is having a better time with their knees, Emma x

cdubb

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Re: A.C.I performed this morning but I'm struggling
« Reply #1 on: November 12, 2010, 06:46:02 PM »
Hi Emma,
Sorry to hear you're having a rough time.  I'm in the US, so I was discharged home about 90 minutes after my patella ACI/AMZ on Nov. 3rd.  They do a lot more outpatient here than I've seen in the UK.  I fared perfectly fine my first few days at home even with the tuburcle osteotomy also.  I think we may get better pains meds over here than they give you based on what posting I've read though.  Hope things turn around over the next few days!  Good luck with your recovery and please update.  We're only 9 days apart on our ACI recoveries.  I have a post op thread going if you want to ever pop in over there.  It's titled "My Nov. 3rd patella ACI/AMZ (aka TT or Fulkerson).

Offline Rennschnecke

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Re: A.C.I performed this morning but I'm struggling
« Reply #2 on: November 12, 2010, 06:50:41 PM »
Hi Emma

I'm sorry you're having such a bad experience.  It really shouldn't be like that.  Are you in the UK?  If so, I'd guess that your injection into the stomach is Clexane (R), a standard post-op medication to help reduce the risk of forming blood clots that could lead to DVT.

Did you take any of your normal meds into hospital with you?  If not, is it feasible for your husband to go fetch these for your stay in hospital?

The hospital cannot discharge you until your pain is under control, so don't try to be tough.  Let them know if you are in any pain whatsoever to ensure that you're discharged with suitable meds.  BTW IV paracetamol is supposed to be stronger than the oral equivalent so you may find it works.  If not, keep pressing the buzzer.

I hope things get easier for you soon.

 ;)
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.

Offline summerfun

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Re: A.C.I performed this morning but I'm struggling
« Reply #3 on: November 12, 2010, 07:58:40 PM »
Thanks Guys,
 
I am here in the UK at Stanmore in Middlesex like so many others I have read, they were great the first time round I have to say but this time it's been a bit of a nightmare. The paracetamol is not iv just a little normal over the counter one which is why it done nothing and I was not allowed to bring my meds in as some are controlled and they don't even use one of them here. In fairness the nurse has now said hubbie can now bring them in but we live 110 miles away so was only making journey back when I  being discharged which I hope will be tomorrow, although husband and son left here at 4.45 and still not home yet so feel guilty for that now to.

I have now had oral morph, tramadol, dihydrocodein and paracetamol so am feeling a bit more comfortable now, hinged brace has arrived to be fitted tomorrow and forearm crutches and frame so hopefully will be able to use toilet again.

My defect was on the back of the patella but I do not know size etc but hope to have more info tm, physio has advised that I am NWB for 2-6 weeks and I will have to follow there strict protocol with my hospitals physio dept.

Thanks so much Guys, although I would not wish on anyone I am glad there are peeps out there that understand x

cdubb

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Re: A.C.I performed this morning but I'm struggling
« Reply #4 on: November 12, 2010, 08:06:27 PM »
Always fascinates me the different rehab protocols...I am only partial weightbearing due to the ostetomy, but for that  my docs protcol allows for full weightbearing for patella defects alone with no AMZ.  Even now with AMZ, I can to heel/toe touch (or 25%ish).

Since you had a patella defect, did you have the AMZ also?  My doc routinely does them for patellar defects (if not previously done)because it unloads the defect.  All docs have different theories though.  Melissa on the boards had a patellar defect and her doc didn't do it at her patella ACI on 11/8.  Specifics of each case I'm sure play into it as well such as exact location on patella, etc. 

Offline Melissa S

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Re: A.C.I performed this morning but I'm struggling
« Reply #5 on: November 12, 2010, 08:39:47 PM »
I am now allowed 50% weightbearing but I haven't really done that yet due to pain.  It is helpful when trying to navigate stairs now that I know I can touch down to balance myself.
Injury with knee hitting concrete 7/07, partially torn ACL, and cartilage damage
Scope and debridement 2/08
2nd scope 1/10 with carticel biopsy
Carticel implant surgery on 11/8/10

cdubb

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Re: A.C.I performed this morning but I'm struggling
« Reply #6 on: November 12, 2010, 09:04:31 PM »
50%...that's good progress...that is actually the ability to stand normally with weight equally distributed.  If pain allows of course....  I worry I am exceeding my heel/toe touch/25%.

Offline Rennschnecke

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Re: A.C.I performed this morning but I'm struggling
« Reply #7 on: November 13, 2010, 12:11:03 AM »
Hi Emma

I understand the 110 mile journey.  I was in the same position and my OS arranged for me to stay in for 2 nights to ensure I was stable before a long journey.

I'd be tempted to question the physio further on the weight-bearing status.  If your knee is straight then there can be no forces acting on the patella graft even if you are weightbearing.  It is different for those who have their condyles treated.  The thing to beware of is damaging the graft through shear forces that arise from bending and straightening of the knee with a load – which includes active motion.  The rest is down to what you can tolerate owing to pain.

I had two grafts, one on the patella and the other on the trochlea and it was feared that I would end up rubbing the grafts off because they were 'kissing'.  I was just advised to keep my leg straight but I could weightbear as tolerated.  Did not have an AMZ which changes the rules because your bone is broken in that procedure.  My grafts have not been worn off (15 months post).

I think it's worth checking as even partial weightbearing can make your life an awful lot easier for getting around.

PS  The traffic tomorrow is anticipated to be really bad if you have to go on any routes that link into routes to Twickenham.  Big rugby match on  – I need to go to Teddington tomorrow so need to go really early to ensure I get to my appointment on time :(.
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.

Offline summerfun

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Re: A.C.I performed this morning but I'm struggling
« Reply #8 on: November 13, 2010, 09:50:51 PM »
Well today just went from worse to awful and i am left wondering if i have done the right thing...

First of all the ward got a phone call at 7.45 fromm the HDU ward saying they were transferring two new patients to the ward to which the ward sister said they could not as their were no beds, the conversation continued but i could not hear the rest of what was said, but the next thing i hear is the sister phoning someone telling them that i was to be discharged this morning as they needed the bed. Then at 10am a consultant done ward rounds and when he arrived aat my bed the nurse said i had had a A.C.I done yesterday but they needed me to go home today due to bed shortages, he asked me to wiggle my toes to which i obliged and then said once physio had fitted the hinged brace i could go. I asked him if he could do me a prescription for my pain medication to last me till monday when my own doctors surgery would be open and i could sort more out then, he said he would and off they all went.
Then their was a uproar coming from a gentleman further up the ward, the abuse and language was extremly colourful and for the next two and half hours it seemed that every tom, dick and harry was investigating the mans complaint and needless to say we were all left and opur medications were given to us late. At 12.35 the physio lady finally arrived and as she was one of the people who had been screamed at from the man she looked extremly flustared, anyway she removed the brace from the packaging and said ' you must be used to this as you would of used one last time' to which i said no so she then said 'oh did you use the one you have on now?' and i said no i did not have a brace when i had stage 1 done, by now she had got the brace ready to be fitted and went on to do so explaining that the hinges need to be on 0 and must stay locked straight for 6 weeks and i was to be NWB for 6 weeks to! I asked her if she was sure about that as i thought it was only 2 weeks as that was what the consultant had said yesterday and she said no in the post op notes it clearly states 6 weeks. I was then told to keep the hinged brace on during the day but i could put the other brace on at night time, i was then given a elbow zimmer frame to use and shown how to manover it, she then signed me off and said i was free to leave. The nurse then came over and said give me 2 minutes and ill be with you, by now my husband and son had arrived so we packed my bits up and waited, 20 minutes later and she whipped past and said i havent forgotton, 2 minutes needless to say 45 minutes later we were still waiting so we made our way over to the reception and said i needed to sign my discharge papers and i would be on my way, the receptionist got my paperwork out and asked me if anyone had checked my wound and i said no, so she calls the nurse over and tells her that she must check it before i go. Back to my bed again and the nurse roughly removes my brace and starts undoing the bandage and dressing and comes across a huge white/clear plaster covering my wound and said yes thats fine, wait a minute and im just going to get a clean dressing.
When she comes back she has a huge long peice of tubigrip and proceeds to start trying to yank it up my leg to which i let out a scream as the pain shot through my knee like nothing i had felt and she says well if you bent your knee it would help and with that puts her hand under my knee to push it up and bend it, i cried out and shoved her hand away and my husband yanked the cutain back to see what was going on and then shouted at her what on earth are you doing she is not allowed to bend her knee and how the hell are you going to get that tubigrip on her, her knee is massive and has staples going straight up through her knee. The nurse then said that the woman ono worry about stairs reception told her i had had a arthroscopy and had stri strips in, i told her to get off and my husband helped me to re-dress my knee in the orignal dressing and put the brace back on, the nurse in the mean time apologised saying she was so sorry for the awful treatment i had received. The receptionist then came over and asked what was taking so long, so the nurse told her and she said she was sure my post op says steri strips and arthroscopy and walked off, then came back and said on my post op it says steri strips but on letter for doctors it says clips so how was she to know! The receptionist then gave my husbands some scissors and dressings and says i need to make a appoinment to have them removed in 2 weeks time and the tools would need to be given to the nurse, she then asked him to sign his discharge note to which my husband said 'why the hell why i sign it when my wife is the patient and not me' , he was really annoyed by this point so i signed and said if they could give me my prescription meds i would be on my way. The receptionist came back with a bag with my name on and asked the nurse if i was to have everything in there, the nurse said no some was to stay so they started to get them out, in there was 2 more clexaine injections that i had not been given so i only hope i was only meant to have 1 and the 2 others were in there by mistake, they gave me a box of paracetamol and the nurse said the rest was to stay. I then asked where was my prescription that the consultant done me this morning for Tramadol, Dihydrocodeine and Oramorph, once again the nurse went off and then came back empty handed and said they did not know what had happened to it and the pharmacy was now closed and if they call the on call pharmatist this could take another hour, so i told them to forget it and i would try and sort something myself when i got home.

We finally left empty handed and feeling really let down, i had not been told whats been done, i have no exercises or been told if i have to do anything to the knee at all, the only thing i was told is that i can shower as soon as i feel like it so will defiantly be trying that as soon as i am up to it.
When we finally got home it took 3 hours for the local on call doctors to sort me out a prescription by which time i was in agony again, i feel really let down by all thats happened today although i was not the only one as the woman in the opposit bed had her op cancelled for the 5th time and the consultant refused to come and see her to give her a explaination! They eventually told her she was to return on tuesday and he would try and do it then but cannot gurantee as he has 2 other people booked in and if they are complicated then he wont fit her in, so all in all mine could be worse.

If anyone has any advice of what they think i should be doing then please let me know as i have not got a clue, i know you all seem to mention ice but i was not given this in hospital and have not been told to do this either, in fact all i know is i do nothing until i see my local physio in 6 weeks who will then adjust the brace to 45 degrees and they will have a physio protocol to follow from Stanmore and that i should receive a follow up appointment in the post.
My husband and boys have brought a single bed downstairs for me when i got home so i dont have to tackle the stairs, sorry to go on people but i feel really low right now but hopefully a decent nights sleep in my own home will help with that  .....

Emma

Offline Rennschnecke

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Re: A.C.I performed this morning but I'm struggling
« Reply #9 on: November 13, 2010, 10:36:24 PM »
Emma

I really feel for you!  :'(  I heard all the compliments about Stanmore and wondered whether I wouldn't have been better off there – it's certainly closer to home than my hospital.  But your experience is really harrowing.  I'm so sorry it's happened to you.  :(

First of all, the Clexane is supposed to be administered for 7 days post-op (NICE guidelines), unless there are good health reasons for not giving it.  The nursing staff should have gone through how to administer the injection to yourself and provided you with the full course.  This medication is supposed to reduce the risk of DVT which is life-threatening so please get your husband to make a fuss at the nurses station tonight to check out whether you need the get the out-of-hours service to prescribe this.

For your early stages of rehab, keep the knee iced as much as possible, elevate and rest apart from doing some exercises 3-4 times a day.  The exercises you can consider doing include ankle pumps and circles if you can manage it.  Quad sets and SLRs if the latter can be done without pain.  To reduce the risk of adhesions, I would recommend doing patella mobilisations gently and gentle massage as well as can be done through the dressings but I suggest holding back and getting someone to hassle the surgeon on Monday to check what's what.  If you can do any stretches without bending the knee it would help and any exercises that don't involve the knee, e.g. upper body and core exercises, can be done.  You could also visit the following website for more info http://www.cartilage-repair.co.uk/.

I'm worried about the tubigrip affair.  I know that different clinicians hold different opinions but I heard one consultant on my ward tear a strip of the staff for even considering it for anyone.  I also think that tubigrips can put extra pressure on the patella that you can do without at the moment.  This is another point to bring up with your surgeon.

Have you got all the meds you need now?  I hope so and hope you get a good night's sleep.

Take care!  :-*
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.

Offline vickster

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Re: A.C.I performed this morning but I'm struggling
« Reply #10 on: November 13, 2010, 11:16:50 PM »
Oh dear, what a horrid experience :(

If I were you, I'd call the surgeon's secretary on Monday with a list of all your outstanding questions.  Which surgeon is it, should have own sec at the hospital.  If you get no joy, ask your GP to call up to explain your concerns :)

Hope you have a restful night
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline summerfun

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Re: A.C.I performed this morning but I'm struggling
« Reply #11 on: November 13, 2010, 11:23:57 PM »
Hi Renn,
Thank you so much for your prompt reply, I do now have my prescription and am feeling a little more comfortable although my knee feels extremely hot but I know this is to be expected. I am really concerned about the clexaine injections as I am at risk of blood clots as I am on hrt although I had to stop taking them 12 weeks ago to decrease the risk, I still have the White stocking on my non operated leg but am unsure what I can do about it now as it's only emergency out of hours gp service available.
I will try to make enquries but fear it will fall on deaf ears as getting my pain medicine was bad enough but will give them a try if not I will do so again in morning.

I have to say I am in complete shock over the treatment I have received as when I had stage 1 I could not fault them so I think that's why I am so taken back at just how little information I have been given.
I have just read my gps discharge letter and it clearly states on it that I have had a R knee arthroscopy with steristrips! Wound check on 17.11.10 and removal of strips on 23.11.10 and the physio has ticked mobilising safely, stairs Not To Do Stairs, advice sheet given ( no they have not) and discharge goals ticked which was me being able to use the zimmerman frame. The final bit is a follow up appointment to be sent for 6 wks time, but I am going to wrong Stanmore Monday morning and see if I can get some answers, once again than you very much for you help and advice, Emma.

Offline summerfun

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Re: A.C.I performed this morning but I'm struggling
« Reply #12 on: November 13, 2010, 11:30:00 PM »
My consultant is Mr Carrington although I have not seen him since my initial appointment back in June, when I came in for stage 1 I saw Mr Mallack and he performed it and again this time I had him so I will try and get answers from him on Monday.

Thanks Emma.

Offline Rennschnecke

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Re: A.C.I performed this morning but I'm struggling
« Reply #13 on: November 13, 2010, 11:48:44 PM »
Hi Emma

It worries me that you are in the category that needs Clexane – please pester the hospital tonight so that someone can either go to the out-of-hours service for help or the nearest Walk-in Centre.  I think in your case it is important enough to do this.

I'm surprised that you've been discharged with a walking frame.  I was discharged with crutches (well I actually have my own), but they checked I could ascend and descend steps safely.  This is because even if you sleep on the same floor of a building your may have to climb steps to get in.  I have 7 outdoor steps to even get to my house.

If you have a discharge sheet this is often written up by the attending dr on the ward not your OS.  Full details of your op and care will be in a letter to your GP.  When you phone on Monday check whether a copy has been sent to you.  If not, request a copy and be prepared to use it when you see your physio.

I'm also surprised that you won't be seen any sooner than 6 weeks.  I had an appointment at 2 weeks and then at 8 weeks which was the 6 week check.  If you have any concerns whatsoever before 6 weeks pester the department again.

If you need any adaptations at home try to contact the Red Cross.  They have equipment that you can borrow for the short term.  It's much quicker than going through Occupational Therapy, although you may also want to make enquiries there as well just in case you need some equipment for a little longer.

Get some ice on that knee of yours!
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 #14 on: November 14, 2010, 01:32:56 AM »
Yikes Emma...that's a scary story!  I'm sorry you went through such an ordeal.  I wasn't in a category that needed any anti-coagulation therapy other than to take an asperin per day for 2 weeks even though I had and osteotomy as well, so I'm guessing you have other medical issues/factors different than I do to have put you on that.  Since they started that medication, I agree that you make sure you get that sorted out if you haven't already.  I'm guessing that Clexane is like a Coumadin or Lovenox that is used here. 

As for exercises to do, Renn def knows what he is doing, as he posted some recommendations to me on another thread.   I also have no idea how to navigate the UK medical system.  Here in the US, I just e-mail my Dr.'s PA (or my Dr.) with questions and I generally have a response within an hour or so. When it's been a more serious matter, I've gotten responses within 15 minutes via e-mail. 

I also am a patella ACI (albeit w/ AMZ) and I am doing quadsets and ankle pumps and dangling the leg 3 x's per day over the bed to 90.  I am attempting straight leg raises...somewhat unsuccessfully though.... 

My brace was locked in extension until my first post op on Friday (9 days out- formal protocol says 0 until 2 weeks, so I was a bit early) and then it was opened to 30 where I will stay for 2 weeks and then I'll go to 45 for a week and then 60 for a week.   Luckily, my wound was closed with dissolveable cosmetic sutures and glue, so I didn't need to worry about any staple or suture removal.  I can't figure out why anyone even uses staples actually?  Anyone out there know why staples are even used anymore? Is there a benefit that I don't know about.

Did you ask about the weight bearing restriction??  Everything I've read about PF ACI is full weight bearing...heck...I even had my tibial tuburcle cut off, moved and screwed back down with my patella ACI and I am 20-30% weight bearing. NWB just seems very odd to me??

As for equipment for home..highly recommend shower chair with rails for stability getting in/out of shower, raised toilet seat with rails and I found the leg lifter strap very helpful.

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.

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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.

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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....

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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.

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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.

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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. :)















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