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Author Topic: A.C.I Update with Findings  (Read 1898 times)

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Offline summerfun

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A.C.I Update with Findings
« on: January 17, 2011, 10:26:42 AM »
Hi All,

I hope everyone is recoverying well and enjoying the new year so far  :)

Well i had my follow appointment on Monday 10th Jan and actually saw Mr Carrington but i remain unimpressed with the response's i got from him and still have no answers as to why things went wrong with my stay at Stanmore only a reassurance that he would get his secretary to look into it. As for my recovery he confirmed that the knee has got stuck and so i am being re-admitted to Stanmore for a over night stay and they are going to put me under a GA and apparantly they force the knee to bend, once this has been done i should be able to start moving forward in terms of my rehabilitation. He did however tell me to ditch the brace and crutches and start fully weight bearing which i have done and my knee has been killing me ever since, in fact its got worse as the weeks gone on but i am pushing throught it and trying not to let it get the better of me. I suppose going from 9 weeks non weight bearing to suddenly walking around on it, this was never going to be easy  ;)

I have been to see my G.P this morning and filled her in on what was said and she said they still have not heard anything from Stanmore since i had the A.C.I back on the 12th November and showed me the letter she got back then. This does not give them any information as to recovery time and how long i should be off work for which was my main reason for visiting her this morning, but the letter she did have explained there findings so i got a copy of that from her. I'm not sure but i think mine is not to bad but this is what it says; 1.5 x 1.5 grad IV lesion involving the medial and central patella - lesion curetted to normal cartilage edge and base prepared with anchor points. Graft implanted with Tisseal glue - Stable to 45 degrees flexion - Lateral release performed. I am hoping when i go back in i may get some more answers then as at the moment i feel like i am in limbo, my physio as been put on hold until after they have released my knee so i can get ROM as she feels i can do no more until that has happened.

The reason i was asking about my return to work was i am a personal assistant / carer to a disabled family in their home and i took my SSP form into the employers only to be told that i am being made redundant due to the families circumstances changing and needing round the clock nursing care now, which is fine but this leaves me in a really difficult situation as once this SSP note runs out on the 26/01/2011 i have to go to the job center to sign on, i need my G.P to do the SSP notes but she needs advice from Stanmore as to how long until i am fully fit for work but i think that is going to be a hard one as if you have a office job you can return quite quickly but if like me its more manual labour i would imagine longer. I am just worried that while trying to recover i am going to be expected to be signing on and going to job interviews even though i cant walk properly, sorry to rant on i am just feeling so frustrated right now.

Thanks Guys x

Offline Rennschnecke

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Re: A.C.I Update with Findings
« Reply #1 on: January 17, 2011, 05:15:42 PM »
Summerfun

Sorry you didn't feel satisfied with the OS appointment.  In all honesty, the OS has no control over how a ward is managed that is the province of the nursing staff.  If you want to register a complaint you can do so through the channels set up for this.

If FWB is causing pain, try using the crutches to help you.  I'm sure that if you get back to your OS to explain how much pain you are in, he'll suggest a phased reduction on crutch use.  I've found that they seem to assume you understand that aspect of it and don't realise that some people will take them quite literally.

The time you will need off work should ideally have been discussed with your OS at the beginning.  If you need a specific letter to support your time off then phone up Mr Carrington's secretary and make your request then.  I've asked for letter from my OS to support medical exemptions etc and had no problem, but this was specifically requested.  You may find that you will need to be off for 6 months or so, but it really will depend on how you recover and 6 months is a long time to predict.

If you are on SSP I don't expect you'll be expected to attend job interviews etc., but you should discuss with your GP what your limitations are and what work you might be able to do.  The sick notes have been changed so that they are no longer total exemptions from work but they will outline what adjustments need to be made to enable you to work.

As for physio, just continue to do what you can of the exercises you have been given so far.  This just keeps everything working until the op.

HTH
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 Update with Findings
« Reply #2 on: January 17, 2011, 11:35:17 PM »
Hi Renn

I understand about the OS not having control on what the nursing staff do but it was more the fact that I ended up on the wrong ward and never saw a consultant or knew what I was meant to be doing when I was discharged and from a consultants point of view it must be a concern as my recovery has been hindered by the lack of communication.
As for my work I'm sure I will get some answers on that one from my G.P as she said she was going to contact Mr Carrington but this afternoon I got a phone call from my doctors surgery to say that my G.P had received a letter from Stanmore and she has done me a copy so I will collect that tomorrow and see what it says.

With all your knowledge do you know what my post op findings mean? Also I have two small things worrying me which I'm sure is normal but would just like to hear from you that it is, I am getting sharp pain on the inside of my knee and also on the outside top end of my knee cap, these are sharp twinges in the morning but by evening are consistent and in the night if I turn over I get woken up by it? The other one is my foot has got really painful in the last couple of days with swelling from my ankle to my toes, is this just from where we have been NWB so to be expected?

Thanks for all your advice, I really do appreciate it, Emma x

Offline Rennschnecke

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Re: A.C.I Update with Findings
« Reply #3 on: January 18, 2011, 01:33:50 AM »
Hi Emma

I appreciate that you are frustrated about the mess up with the wards, but to be honest communication mess ups do not seem to be that uncommon.

it was more the fact that I ended up on the wrong ward and never saw a consultant or knew what I was meant to be doing when I was discharged and from a consultants point of view it must be a concern as my recovery has been hindered by the lack of communication.

I'm sure the consultant will be fed up with immediate post-op care messing up recovery. At my first consult my OS seemed very pleased with my progress until he saw the state of my knee. It was all horrendously scarred up despite the fact that he had taken special care to make my scar small and neat. But the ward staff had neglected to change my dressings and attend to the wound appropriately. All he could do was apologise, but the way his face fell told it all. There is probably very little they can do. The fact that you didn't see a consultant could be attributed to you being on the wrong ward, and whilst they may keep requesting to see you, general organisational mess-ups can just prevent that. I know you don't want to hear that, but I know many of the clinical staff are fed up with 'missing notes' issues.

With regard to your notes from the op. As far as I can tell it is a standard report of the procedure.

1.5 x 1.5 grad IV lesion involving the medial and central patella
This indicates that your cartilage defect was c. 2.25 sq cm, so on the smaller side. Grade IV means it was full thickness wear, which is normally the case for MACI, and the defect was located at the central and inside part of the patella.

lesion curetted to normal cartilage edge and base prepared with anchor points. Graft implanted with Tisseal glue
The lesion was cleaned up and prepared in the standard way so that the normal cartilage had stable edges to integrate with the implanted cells and the bone was ready to receive the graft. The graft was fixed into the space using the glue mentioned.

Stable to 45 degrees flexion
I think this means that you can flex your knee to 45 degrees quite safely without fear of damaging your graft.

Lateral release performed.
Your OS also performed a lateral release. No reason is given for the lateral release but it is often performed when the tissues on that side are tight and interfere with the mechanics of the knee.

As to your current pains in and around the knee, it may be due to the grafts being immature and you being sensitive to this or to adhesions being irritated. If your pain increases through the day, it suggests that you're overdoing things and need to rest up more, in particular ice and elevate your knee. Waking during the night is particularly unhelpful. In that case discuss with your GP about adjusting your pain medication and consider elevating your leg overnight and icing if you can do so safely. I'm still using my cryocuff and elevating every night. It really helps with pain management.

The swelling and pain in your foot may be due to circulation problems if so this can be attended to with regular ankle pumps as well as elevation. The pain may be due to swelling. If the pain and swelling persists then see your GP for an initial consult. Alternatively, you may wish to contact your OS in case they know of other things to look for which might not normally be considered.
 
If you have any queries about your notes and can't wait till your appointment with your OS, I've always found that I could send my queries to my OS either directly through email or through his secretary. If you wait till you go back into hospital you may find that you forget to ask in the rush of going to surgery or your OS may be delayed in theatre and may send someone else to see you etc. So it's well worth getting in touch in advance. Besides which, when you deal with your questions separately you may be able to think of further questions once you've been able to take on board the answers.

HTH
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.