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Author Topic: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 10/3/13  (Read 30903 times)

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Offline chondro...huh?

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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 10/3/13
« Reply #15 on: October 17, 2013, 06:14:27 PM »
I know the pain and  lack of sleep suck, but it sounds like you are really doing great. Do all naroctics make you sick? Some people react differently to different meds. For example; Codiene makes me nauseated no matter what I do, Tramadol wires me and makes me a paranoid insomniac, Hydrocodone will upset my tummy a little unless I eat a snacck with it but otherwise I tolerate it ok. The medications are all processed by the liver and kidneys not to mention the way the work within the nervous systmem and pain receptors differently thus why some might not effect you as badly as others. If you havent yet tried Codien, hydrocodone, oxycodone, tramadol, fentanyl, morphine.... talk to your doctor and try something different. I cant immagine having gone the first 2 weeks without my pain meds. Pain really messes with your abiltiy to heal and really messes with your mind and spirit. Especially this kind of pain.

Your flexability is phenominal! Way to go!
Susan
07/12 - injury
03/13 - scoping, cleaning
09/13 - TTT

JFVolleygirl27

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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 10/3/13
« Reply #16 on: October 18, 2013, 03:27:39 PM »
Thanks Susan! The pain is usually bearable during the day, it's just at night I can't sleep with it. Last night was better. My doc called and told me to pick up some tylenol pm and take that alongside the sleepy meds I was prescribed. Together it worked alright. I'm so tired of sleeping on my back....but my side is still too uncomfortable even when using a pillow. Hope you are doing well too!

Post op day 15

Today us better. I slept better last night. I felt really good after my therapy session - the pain wasn't too bad. We didn't measure my rom yesterday, but we measured hyper extension and I am at 2. My left leg is around -8 to -10. So it is my goal to get my right leg up to par. I have full rom in that leg too, so same goal with that. I just keep doing prone hangs and cannon balls. I've been working on hip abductions too. These I can do. But straight leg raises are another stories. My therapist had me try to life my leg straight while standing up....she helped me get my leg out and then told me to slowly lower, and it just plopped back to the floor. It would have been amusing if I wasn't so frustrated by it.

I am still getting a really sharp pain on the lateral side of my lower thigh like where the femoral osteotomy was. This is by far the worst random pain that I have had....when I stand up sometimes (unless I go really slowly) I get that sharp pain and then once I'm up it's over. It feels like the screw is poking into the it band or something. But I know this isn't the case bc the pain only just started two days ago.

Other than this nothing is new. I'm just bored out of my mind, and all my friends are away at college.

Offline Aubie

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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 10/3/13
« Reply #17 on: October 18, 2013, 07:37:12 PM »
I completely understand the not sleeping and the pain at night!  I'm at 9 weeks post-op (just MPFL reconstruction) and STILL don't sleep very much.  My knee initially feels fine, but then I wake up every 1-2 hours and it's killing me.  It just feels like a really deep ache, and when I change positions and try to stretch it out a bit, it subsides, and then I start the process all over again!  I am not taking any sort of pain meds though (stopped the day after surgery since I thought that the pain wasn't as bad as the way I felt on the meds!).  Ugh - I'll be so very happy if I ever feel halfway normal again!!

JFVolleygirl27

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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 10/3/13
« Reply #18 on: October 20, 2013, 12:17:22 AM »
Post op day 16

Everything's going alright. I'm still having that pinching pain on the lateral end of my thigh which I think is just my it band freaking out. My doc told me that it gets stretched slightly from the distal femoral osteotomy so this is likely. Other than that just lots of stiffness in the ttt area when walking and bending, and occasionally pain in front of the kneecap when sitting.

I got back to Houston on Tuesday to get stitches out so I'm looking forward to this. Well not the removal part but after they are out. And it's freezing here so I'm looking forward to warm weather. 

Sleeping is a bit better. Especially last night. I went to Mexican for my 22nd bday coming up, and all the tequila put me right to sleep last night :) I still don't have a huge appetite for food though. I haven't since surgery. Last time with my left knee surgery, I had about 75 grams of whey protein shake every day on top of meals. I just can't stomach that though again for some reason. I wish I could though because my left knee healed extremely fast - I think the excessive protein really made a difference. I miss having an appetite. But now I feel like I'm going to get nauseous after eating sometimes.

I just got my new bike from Walmart today! But now I need to get batteries for it.

JFVolleygirl27

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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 10/3/13
« Reply #19 on: October 20, 2013, 08:46:51 PM »
Everything is going well pain wise with my knee today. The swelling has gone down significantly. Ironically my stomach is now giving me more problems than my knee. I got really such last night and threw up like everything in my stomach. I didn't really digest anything yesterday and the feelin just got worse through the day. Not sure what is going on - I think my stomach lining may be inflamed from the NSAIDs like aleve. I quit taking that yesterday anyway just in case. I could have also caught something in South Africa. I will see a doctor soon to try and figure out my odd stomach pain and nausea problems. It's interfering with my ability to do my therapy like the bike and stuff bc my stomach just hasn't felt great, and yesterday and today I have just felt weak. Anyway I changed my diet to "ulcer safe" food as a precaution.

Offline chondro...huh?

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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 10/3/13
« Reply #20 on: October 21, 2013, 03:30:07 AM »
Whenever I have surgery I have to take omeprazole for a few weeks to keep it settled down. This time it took a month worth.
Susan
07/12 - injury
03/13 - scoping, cleaning
09/13 - TTT

Offline Lee Tipton

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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 10/3/13
« Reply #21 on: October 22, 2013, 10:48:04 PM »
Dear JFVolleyGirl,

I just have so many questions - and I understand if you are not up to answering all of them.  I also want to say that I feel really badly about your tummy issues.  And I will go one step further by saying - go to the doctor about it please.  My husband died 16 years ago.  He was a severe diabetic and had been since we were children.  But the thing that really got him was his stomach.  He vomited even when he brushed his teeth.  Please go to the doctor about this problem with your tummy.

I am scheduled for a DFO 2 weeks from today.  I am also much older than you as I will be 60 in March.  However - I am just shocked that you are allowed to get up and put weight on the leg.  I am being put on NON weight bearing for 10 weeks after this procedure.  I have had a medial menisectomy done 40 years ago and maybe that has something to do with it.  And it may be because yours was so much more entailed than mine is.  You had many other things done besides just a DFO.

But could you please enlighten me?  Is it because you are in such good shape and an athelete?

Thank you,
Lee Tipton

drmark

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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 10/3/13
« Reply #22 on: October 23, 2013, 01:28:45 AM »
Since this response has nothing to do with JFVolleyGirl, I an not violating privacy laws in putting my two cents in.

I have never figured out why if someone's Granny has a broken femur and it is fixed with a blade plate, and since most Granny's don't have enough strength in their arms to be on crutches, non weight bearing, they are allowed to  immediately walk on their repaired bone, while a younger and stronger individual is told to be non weight bearing, even thought the younger person has better bone quality.

Since, I always question the conventional wisdom, I allow patients to take weight on the leg from the get-go.  So far in dozens of DFOs, no one has been the worse.

Having said that, I allow patients to take full weight under supervision for exercise, confidence building, and to encourage bone healing by loading the bone in compression.  I still want patients to use two handed support with partial weight bearing for ordinary activities.
« Last Edit: October 23, 2013, 01:57:29 PM by drmark »

Offline Lee Tipton

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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 10/3/13
« Reply #23 on: October 23, 2013, 04:15:32 PM »
Thank you so much Dr. Mark.  I promise that I will do as my doctor allows me to do.  I am a UC Davis patient out of Sacramento, California.  My doctor is Dr. Giordani.  He is tough and I would not want to not do as he instructs because he has only my best interest in mind.  That and the fact that I am overweight has a lot to do with his instructions.  I am losing my weight now and I know that after the surgery I will lose much more.  I have done so much studying on this matter.  In that study I have read that it can take upwards of 6,000 calories per day to mend a femur bone.  YAHOOOOOO!!!  That coupled with the fact that I have already lost close to 30 pounds on my own and I should be skin and bones by the time I vacate the crutches!!! 

But I value your information as it will keep me calm if I happen to have to balance myself on the operated let to keep from falling.  But for the first two weeks after surgery - I plan on planting my behind in my recliner and letting my kids pay for their raising by taking care of their mom.  I have 3 of the greatest kids to ever walk on 6 feet.

Sincerely,
Lee Tipton

drmark

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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 10/3/13
« Reply #24 on: October 23, 2013, 09:04:38 PM »
If it took 6000 calories per day to heal a femoral osteotomy, I would be very surprised.

I saw one of my patients today who had a DFO three weeks ago.  She told me that she was eating about 1500 calories per day.  She is making excellent progress and here X-rays look great.  If this was the case, and her femur was healing fine, then she would have burned up 4500 calories of herself every day.  Doing the math, and remembering that a pound of lard is created with ever extra 3000 calories, then she would have had to have lost 31.5 lbs. since her surgery.  Sadly for all of us, but good for her skinny young self, she tells me her old jeans fit the same way.                                                               

Offline jumbocrayon

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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 10/3/13
« Reply #25 on: October 24, 2013, 01:04:04 AM »
Sorry to hear about the stomach troubles- I'm 3 weeks post-op and right there with you.  I have had the worst nausea, and threw up last night too.  My doctor prescribed something for the nausea right after my surgery that worked pretty well, but he only did a few doses, but with 3 refills that my insurance won't cover unless its been more than a certain number of days, so I have to wait a few more before I can use it again, or pay the out of pocket cost, which i'm not really keen on.  I've been doing a small amount of tea with ginger throughout the day, which helps a little, but obviously not enough to keep me from occasionally hurling.

Hang in there :(

Offline Lee Tipton

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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 10/3/13
« Reply #26 on: October 24, 2013, 04:15:20 PM »
Dear Dr. Mark,

I went to look up the article that I have based my theory on - and  - I stand corrected. 

Fracture prevention & healing
How to speed fracture healing   by Dr. Susan E. Brown, PhD

While a normally active adult may require 2,500 calories a day, a bedridden, injured patient with multiple fractures may need 6,000 calories per day! If this demand is not met, the healing process is compromised.

But I want you to read the article for yourself - it really is a good article:

http://www.betterbones.com/bonefracture/speedhealing.aspx[url]]http://www.betterbones.com/bonefracture/speedhealing.aspx

I may not have a multiple fracture - but I am counting on doubling my caloric need for at least a month.  I am juicing now and proabably taking in 1,000 calories (per day) through the week and a few more on the weekends.  I am doing really well on this diet and now believe that I can live like this from now on.  My mother was a huge woman that stood 6'2" and at her heaviest probably weighed about 375 to 400 pounds.  She battled cancer 3 times that I know of and a bout with pancreatic took her in 2004 at the age of 78.  I don't want to live like that in my later years.  I want to be able to take my Down's Syndrome granddaughter to Disneyland and anywhere else our hearts lead us to wander.  This surgery is just a vehicle to get me back to the active person I have always been.

Thank you for your challenge as I appreciate knowing all my limitations and my strengths.  I not only misquoted Dr. Brown - but I believed what I thought I read to be true.  Now I know that I was wrong.  And that is just as important as knowing that I need to be good to my body - all the time.

Sincerely,
Lee Tipton


Offline crankerchick

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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 10/3/13
« Reply #27 on: October 24, 2013, 05:03:16 PM »
I recovered just fine from femoral and tibial derotational osteotomy along with a TTT and I'm actually a calorie counter and I can promise I didn't eat close to 6,000 calories. At the time of my surgery, my caloric intake to maintain my weight was around 2,450 a day (yeah I was a fatty and I had already lost 20 lbs from my heaviest). I rode the bike for an hour a day and consumed around 2,000-2,200 calories daily (yep still have my food diaries from those days). I did take calcium and vitamin D supplements. I was 28 at the time of my surgery and not the specimen for fitness that I once was. I was toe-touch (less than 20#) weightbearing for 4 weeks, then that was upped to 40#. At 6 weeks my osteotomies were healed enough to start weight bearing. At 12 weeks I was full weight bearing, although I was using a single crutch at times, and for longer distance walking. At 6 months my bones were fully healed. I had my hardware removed at 10 months. My hardware bears the evidence of massive bone growth around the plates that had to be whacked and chiseled. Apparently my bones were regenerating in over-drive as I was told after the hardware removal that the growth around the plate was quite impressive and excessive. Hey, go big or go home!

Not that I'm trying to use my single case to refute a claim (that's not good science), I am just saying my experience leads me to believe that if I ate 6,000 calories a day, I would have been a very unhappy person both in how I felt physically (that's a lot of food even for a fatty) and how I looked (can you say massive weight gain). Do what works for you but I would not stress yourself out trying to consume that many calories, or even doubling your caloric intake. There are expert surgeons who do these procedures and treat fractures everyday (one posting here) who don't tell their patients to eat that many calories. They do stress being sure to get enough protein, possibly taking supplements, and being sure to allow for some exercising and weight bearing. There are pieces of medical literature that support bone healing by actually using the limb, otherwise bone loss can potentially occur.

Also, just a thought, since we are talking about what's good for our bodies and healing from surgery, did you know that your current 1,000 calorie diet would send many a doctor, trainer, and nutritionist into a rant about diets like that? It is highly recommended that a woman not take in less than 1200 calories, unless she is a really small lady, like under 5 ft tall, under 110lbs small. I'd be much more inclined to put stock in claims like that, over claims that a person needs 6,000 calories in order not to compromise healing from a fracture. Just sayin'.
« Last Edit: October 24, 2013, 05:30:15 PM by crankerchick »
Mar '07 - plica excision
Oct '09 - femoral + tibial derotational osteotomy & TTT
Aug '10 - hardware removal
"You control your leg. Don't let it control you." -Smart trainer
"Get your a$$ in gear and go for it! Nothing will happen until you make it!" -Smart doctor

Offline Lee Tipton

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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 10/3/13
« Reply #28 on: October 24, 2013, 07:00:46 PM »
Dear CrankerChick,

Thank you - for your input and your concern.  I know - the 1,000 calories per day is a bit lean - but I can barely walk on my ankle and foot right now - so getting in enough exercise is hard to do.  I need to lose some weight before this surgery and I am doing it healthily (if that is a word).  I bought myself a juicer and I am doing vegetable juicing 2 times a day and a healthy dinner.  I am staying as active as I can possibly get.  I know that I am losing weight and I feel really good.  Plus, they are doing blood tests on Monday so we will know how my numbers are then. 

But honestly - I never even considered eating 6,000 calories per day - I was just hoping that my body was going to use up the 6,000 calories per day.  That would kick this diet I am on into OVERDRIVE!!!  But even if we need half that amount for about a month - it would be ok by me.  It stands to reason that if your body is repairing a major damaged spot - it is going to need some extra energy (calories) to do so. 

I hope you are doing well with your recovery.

Sincerely,
Lee Tipton

JFVolleygirl27

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Re: Distal/Medial TTT, MPFL, and Distal Femoral Osteotomy 10/3/13
« Reply #29 on: October 25, 2013, 10:35:58 PM »
Post op day 22

I've finally reached the 3 week mark--I'm so excited to get to the point where I can ditch the crutches and start walking and carrying things at the same time like a normal human being. I've been on them for too long between my injury and then surgery.

As an update, sleeping has been much better. I can now sleep on both sides comfortably enough before the leg starts aching.

The nausea and stomach pain has been much better too. Since my last vomiting episode, i switched to a bland diet with more frequent, smaller meals and kept this up for a few days. I also completely ditched the anti-inflammatories. Jumbocrayon, I tried ginger too and worked miracles! I got some dry ginger from Trader Joes that I have whenever my stomach starts hurting and it really helps. I also had a veggie smoothie that consisted of kale, ginger, yogurt, and apple one day and this helped soothe my stomach. I'm starting to get my sugar cravings back which is a good sign I think––I had a candy bar today, and that went down fine. I think it was just some inflammation of the stomach lining, but even still, I plan to see a stomach doctor here soon just as a precautionary. Insurance is maxed anyway after surgery, so i might as well get a full body check up while I'm at it :)

The knee is feeling a bit better. I got the nylon stitches out in Houston on Wednesday--this completely sucked. There are still a few pieces in there that doc said he would just take out when I get the hardware out over spring break. But other than that, i'm so glad they are out now....it was starting to really really itch. I also got xrays and doc said that they looked good, and the ttt area is almost healed. Doc said I can start walking with as much weight as feels comfortable without pain.  Now that I'm starting to get an appetite back again, I'm going to try and start packing in the protein and go back on all my supplements.

Anyway, it felt so great leaving the house for a few days. All the sitting in front of the tv/computer at home is absolutely killing me, and not even being able to go outside because the weather is so cold, rainy, and windy. I'm planning on leaving again next week and visiting my bro and a friend in chicago––my bro and his roommates go all out and have like an epic Halloween party every year, so I really want to go to this. I figure since I have collected so many compression stockings over the past two surgeries, I could put together a pretty good 1920s nurse costume :) And my friend is coming home from school to visit me today so I'm totally excited to get out of the house and go shopping and stuff with her.

----

Lee, I hope your DFO goes smoothly!! I don't really have an answer to your initial question about weightbearing limits unfortunately so I am glad that drmark answered this. I asked this also when I was allowed to walk full weightbearing at the clinic 5 days after surgery because I was freaked out by it, and he explained the granny analogy to me, and it made sense to me. When I had the same procedure done on my left leg two years ago, I had the same limits and my bone healed really quickly actually. Granted, I didn't have a problem with the meds at that time, and I was able to consume my normal diet. I only ate around 1500-2000 calories in a typical day (i need to eat around 1800 to maintain my current body weight), but while I was recuperating, I was very good about taking all my supplements and I doubled the amount of protein that was directed on the post op sheet by eating lots of whey protein since I was vegetarian at that time. My bone filled in really quickly. Anyway, best of luck with your procedure--the dfo isn't as scary as it sounds :)

Jumbocrayon--I hope that your stomach issues resolve! It really gets in the way of being able to heal properly when you are constantly feeling sick and in low spirits because of it. Maybe you should get it checked out by a dr too if it doesn't resolve itself soon!
« Last Edit: October 25, 2013, 10:40:09 PM by JFVolleygirl27 »















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