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Author Topic: Yankee's Arthrosurface Patello-Femoral Implant Diary  (Read 20603 times)

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Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #30 on: November 12, 2013, 03:53:40 PM »
Thank you all for the support - I have been told I need to see an infectious disease specialist, but no word as to when. I called the surgeon's office, got voice mail, then called the ID office, they said a request had been made for a recommendation for antibiotics, but the ID dr. hadn't replied.  I said "shouldn't I be getting blood tests or something to make sure I have an infection before I start taking more antibiotics?"  I was told I'd know more after the doctors had spoken to each other.  I would prefer not to attack my liver or my kidneys unnecessarily, I want to know if I have an infection first.  So now I'm just waiting. I asked for someone to send me a copy of the path report, I want to know what I am or am not dealing with so my brain doesn't explode with worry.  I actually woke up in the middle of the night and was relieved that I felt good, not sick, which is my fear, that this is going to be a systemic nightmare.  Here's the photo from this morning after I cold hosed. Sutures are TIGHT. With any luck they will be out tomorrrow.

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #31 on: November 13, 2013, 01:01:48 PM »
Surprise, it's still infected.  The infectious disease doctor wants to put me on penicillin, and levaquin. No blood tests, no appointment, just 'take this'.   That freaked me out, and I said no to levaquin.  It's a nasty drug that almost killed a friend of mine, bloody diarrhea after three doses, for months, in and out of the hospital for months, to this day she is affected by what it did to her.  And, in none of the articles I've read is levaquin even mentioned.  I predict a fight but I don't want to take something with permanent side effects if it's not going to do the job.  I don't need to have my insides destroyed and I don't need a ruptured achilles tendon either.  I'm going in to the OD in an hour, there will likely be fireworks because he doesn't like being questioned, and I don't like people making decisions for me with consequences they don't have to live with.  I don't know yet if this is the resistant kind of VRE, but I am assuming so.  Which means I was infected in the hospital in the first op....

drmark

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #32 on: November 13, 2013, 02:18:35 PM »
Treating patients who have prosthetic joint infection with oral antibiotics, rather than complete open debridement of the joint, possible temporary removal of the prosthesis, and IV antibiotics for at least six weeks, is like  threatening someone with a knife at a gun show.  A bad end is not in doubt.

It may be time for an opinion of an Orthopaedic surgeon with interest and expertise in treatment of problem total joint replacement.  Let him/her choose the ID person that regularly deals with these problems.
« Last Edit: November 13, 2013, 03:36:41 PM by drmark »

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #33 on: November 13, 2013, 07:08:50 PM »
I thought that the wound was red because it might still be infected. The doctor this morning disagrees, he says the redness is from the sutures, which will come out on Tuesday.  I was assured that the infection was only in the subcutaneous tissue, it did NOT affect the joint, and the joint fluid was sterile - so the joint is not infected, the patello femoral implants are not affected.  The wound was opened and cleaned out but not down to the joint.  I'm going to trust that is true, based on what I feel.  Then again, there's one spot on the incision that's still draining a bit, and I hope it's not a replay where it gets to be an exit for anything building up in there.

I had a comforting talk with the ID doc who hears my concerns about fluorquinolones, I will not risk that kind of damage, I don't think those should even be on the market, and I bet if given the choice most docs wouldn't take them for themselves if you paid them.  She is willing to consider all options, including IV or injectables, because fluoros are the only oral option and I won't take them. I will see her on Monday or Tuesday, and probably start 'cillins in the meantime.  Meanwhile I'm cleaning the wound with Hibicleanse and flushing with cold water for as long as I can stand it and hoping that this will not be a case of 'treatment was a success but the patient died'....

To add- according to the Path report the Enterococcus was light concentration, and it is not VRE, which worried me.  The Pseudomonas aeruginosa was very heavy, but is also not resistant to any but one drug.  Still, they're all IV or IM....and the chances that I will be compensated for any of this toxic s**t I'm forced to go through because of a dirty hospital??   
« Last Edit: November 13, 2013, 09:21:59 PM by Yankee »

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #34 on: November 14, 2013, 02:54:12 AM »
Well, something I said I'd never take is now in my stomach - Cipro.  I pray it doesn't kill me or maim me or make me sick.  When I got home tonight, I looked at the wound and it was much redder and much tighter than this morning, and I can see the edges of the wound starting to pull apart and starting to get weepy.  I had an appointment with the ID doctor on Tuesday (she is going away until then) but I know it couldn't wait that long, I'd be exploding all over the place again and it would be an instant replay of last week. 

I don't know how I'd manage IV or IM drugs anyway - the time involved away from my job going for infusions would probably get me fired, so everyone hold hands and sing and hope that this Cipro works and doesn't kill me.  Meanwhile I will continue swearing words that would make my mother wash my mouth out with soap, I am so angry that I even have to go through this for something that should have been so simple.  I just got a bill from the hospital for $1600 - I think we will be having a nice long chat about how much if any of that I'm going to be paying considering what happened in their nice dirty hospital.  This infection has cost me big time, my plan was to get my other knee done in early December and that would have been covered by insurance 100%.  Now that's not possible, and it's pretty doubtful I'm ever going to be able to afford to get the other knee done, given how crappy insurance is likely to be next year.  The bill for the surgery was something like 27K, I think that deserves  a little consideration. As if.

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #35 on: November 15, 2013, 02:59:02 PM »
Day 2 of Cipro - I'm surviving it, but the first night was not pleasant, multiple trips to the loo, and now, while I'm not in discomfort, I'm worried about coughing or sneezing, if you get my drift. I"m taking heavy duty probiotics between doses, which I'm not sure is enough to counteract the effects.  This morning my wound looks much less red, so I am hoping it is kicking in and by Tuesday when the sutures are supposed to come out, it will have healed over properly.  The skin was very dry last night, so after I washed it with hibicleans I dabbed on some bacitracin ointment and that seems to have helped as well.  Long may it continue to improve...

PS - it's actually starting to itch a little bit, like a healing kind of itch, instead of being just red and sore and inflamed.  That's a positive to me.
« Last Edit: November 15, 2013, 05:51:43 PM by Yankee »

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #36 on: November 16, 2013, 06:14:03 PM »
Day 3 of Cipro - to my relief, the side effects have waned, and my knee is looking much more normal, and healing instead of weeping. The skin is not angry shiny red, it looks like it probably should have looked the last time, dull pinkish around the sutures.   These sutures needed to come out yesterday, I've had it, they have annoyed me every second of every day.

Someday I hope to find out if the implants actually work. Right now I'm sick trying to walk on one leg, back hurts, hip hurts, exhausted. Hoping for this to be over soon.....

Offline Lee Tipton

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #37 on: November 17, 2013, 08:18:40 PM »
Dear Yankee,

I have been following what is happening to you and it honestly seems like a nightmare to me - so I can only imagine what it must be like to you.

I am not up to current on the knee language - but I can see from Dr. Mark's input that you have had some sort of knee replacement that has now become infected.  You have every right to be scared out of your wits. 

I know that the Cipro is one of the strongest infection meds available orally. But I hope on Tuesday that ID doctor schedules you for IV drugs.  It is really the only way that you have a fighting chance of getting to keep your new knee parts.  It may be that you have let them clean that area out once again - but even that would be better than losing the new knee.

You have been through so much Yankee. You are on our prayer lists Yankee. May God bless you.
Lee Tipton

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #38 on: November 18, 2013, 03:24:52 AM »
Hi Lee,
I had patello-femoral implants - a polyethylene button on the back of my kneecap, and a titanium implant on my femur to glide over each other instead of the horrible bone on bone arthritis I was living with. I *think* that part of it is successful, but it's hard to tell because I got a hospital-acquired infection in the skin.  The doctor insists it has gone to the joint or implants, that it is only in the skin structure.  That's what it feels like to me, but I have no way of knowing, really.  I had a second surgery to open the wound and clean it out.  I had to go on Cipro last Wednesday, as it was still infected and was getting worse. 

The good news is that the Cipro seems to be working, as you can see in the photo below, the skin is much less red, and less swollen.    Itches something fierce and the sutures are starting mess with the skin, other than that I hope I'm in a better place than a week ago.  I am relieved and grateful (so far, it ain't over till it's over) that the Cipro has not caused any horrid side effects, that was my biggest fear.  I'm fearful of my system being wiped out of its defenses with all of these antibiotics, so I'm handling things with gloves and have even stopped feeding my dog his raw food - I can't take the chance of picking up something like salmonella now.  I'm not sure if IV antibiotics are necessary, or advisable at this point, but I have an appointment with the ID doctor on Tuesday, whether there are blood tests to tell whether it's gone or not, I don't know.  Would I let them operate on me again, at that hospital?  I shouldn't think so, there isn't much point if the hospital is that dirty that the infection remained after the I/D.

Considering  that I had this surgery as an outpatient and was probably in the hospital less than five hours, to get an infection of this magnitude is disgusting, I'm infuriated by it and am considering my options as to how I am going to deal with it, I still don't know that I will completely recover or that it has not damaged my joint. I'm trying not to think of that possibility, I'm just trying to be grateful for the improvement so far.

Offline Lee Tipton

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #39 on: November 19, 2013, 02:01:41 AM »
Dear Yankee,

I remember that you were only in the hospital for a few hours.  They used a femoral block and let you leave.  Not Smart!!!

I hope that the Cipro causes your leg to do better and better!! 

I am falling asleep now and must go.
Lee Tipton

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #40 on: November 19, 2013, 02:30:32 AM »
To my great relief, the sutures came out today, (at my insistence!), and I feel so. much. better. 

Unfortunately, my skin is so irritated from the sutures half growing in and being pulled at for ten days, and being constantly rubbed by bandages for a month that it's a little red and weepy now.  I'm not sure what to do about it, besides just makes sure it's clean and not dripping. Ordinarily I might use some cortisone cream on it but with the infection I think that would not be a good idea, so I dabbed on a little aloe and I'll just try to let it dry out without making it worse.  Damn the bandages, you just can't get anything but poly or poly/rayon and they're extremely irritating long term. 

I can't start PT till next week, so I'm taking advantage of 'doing nothing' and trying to rest and rest and rest because I haven't been comfortable in more than a month, i'm tired and I'm bitchy (!) and sick of being sore.  The whole right side of my lower back is pulled from walking crooked and stiff so that's a major pain in the arse, but now that I can bend my knee it should get better shortly.  I hope.  Maybe I'll actually get to enjoy what I suffered so long for.

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #41 on: November 20, 2013, 06:26:34 PM »
The gift that keeps on giving........

So with the sutures out, you'd think it would be clear sailing, right? No.....  I went to the ID doctor yesterday, to be put on penicillin to address the entercoccus, and we decided that there seems to be a fungal infection on the skin on the outside of the wound. After the sutures came out it became more and more weepy, and sore and red and blistery, almost looked like poison ivy. The doctor asked if I had been doing any nude weed whacking, I said not that I remember but I have taken a lot of narcotics lately.... she believes it it some kind of yeast/fungal thing.   Given that I had been on Keflex for a month, that my knee was trapped in hot damp bandages for a month, and then Cipro on top of that, I shouldn't be surprised, but I am.   It seems to have responded to miconazole, the most of the weeping stopped over night, it seems to be drying up and the redness has gone down, hopefully that will do it and I won't have to go on a third drug, an antifungal. This is how people die from crap like this. Wipe out their immune systems and their intestinal flora and compromise their livers and they're ripe for the picking.

I wonder if the doctor's office needs a good, sterilizing clean, this thing blew up completely after the sutures came out and I was bandaged there.  I keep it so clean at home, and I let it the air get to it so it won't always be moist, I find it hard to believe that I'm the source of the infection. If this is what five hours as an outpatient gets me, I'll be damned if I'll ever be admitted to that hospital for anything.

Offline Lee Tipton

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #42 on: November 21, 2013, 03:28:08 AM »
I will say this to you Yankee, your entire situation gives me a reason to pause over a possible knee replacement.  It must be concerning to those taking care of you - at least if they want to know the truth as to what happened to you.  You have been through so much, but in the end - it will be you who will be paying this bill.  No one could blame you for looking for sme compensatioin to help with those medical bills.

I just hope that you are now on the mend Yankee.

Take care,
Lee Tipton

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #43 on: November 21, 2013, 03:55:01 AM »
I'll tell you Lee, I would never in a million years imagined that as an outpatient, there for five hours, that I would ever have contracted a hospital acquired infection that has become such a nightmare.  Two surgeries, months of antibiotics and God knows what side effects I haven't seen yet, not to mention the just plain pain and  suffering of being in this condition and having to deal with the pain AND trying to continue on with my life in the meantime.  My family has helped with getting me places when i can't drive and doing things I'm not physically able to do, but I'm pretty much on my own here, doing this by myself.   I expected a couple of weeks of downtime and I prepared well for it, but the rest of this, the second surgery, having to go drive myself to work the *next day* because I had no sick time left, that I did NOT expect, nor the infection and its side effects and multiple doctors appointments that I miss work for, and it has been excruciating at times. And I still don't know if this infection is gone, will stay gone, if the implants will be affected and God forbid if this goes to the bone.  I'm still trying to get my mind around what the hell just happened to me and why I am not yet using my new knee except one stair at a time.

If I can ever afford to fix my other knee, it certainly won't be at the same place.  I honestly would be terrified to be an inpatient for any reason now.  One you get an infection it just becomes a cascade to disaster.

Offline Yankee

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Re: Yankee's Arthrosurface Patello-Femoral Implant Diary
« Reply #44 on: November 23, 2013, 05:47:18 PM »
Things *might* be looking up.  I put some miconazole on it and it stopped the weeping, but then the skin would crack and it would start weeping again. It was an improvement though, so I called the ID doctor as she requested to figure out what to do next, and was told by her obnoxious, snippy staff that she was "unavailable, as in NOT AVAILABLE",  and that I could leave a message if I wanted "but I have to inform you that she will not get the message until Monday, because she's UNAVAILABLE!". The desire to reach through the phone and b*tchslap someone was overwhelming..... I asked if anyone was covering for her, and they said "no, we could try to contact someone else in an emergency, BUT THIS IS NOT AN EMERGENCY!".  Well, apparently it's not an emergency TO YOU....  So I hung up angry and the nurse called me back, wanting more info, she then "called someone", wouldn't tell me who, and "they" told her to tell me to "continue putting on the cream for the next few days".  Effing BRILLIANT, isn't it? If I wanted to do that, I needn't have wasted my time calling!  I have had it with the half assed help, there will be a conversation about that as well. The doctor herself is wonderful and responsive, her staff, far too obnoxious, and in case anyone hasn't caught on, I am not in a place where I intend to put up with more shoddy treatment - this experience has been bad enough.

So after that non-answer, I took matters into my own hands, we had talked about possibly adding a cortisone or steroid cream to the mix if the antifungal didn't do it.  I had some Temovate in my drawer that I use for PI and for painful lesions when I had lipodermatosclerosis, and I used it in conjunction with the miconazole.  It seems to be doing the trick, the inflammation is markedly improved, but the areas around each suture hole still feel hard and bumpy, literally like poison ivy does.  The weeping has stopped, the sloughing of the skin has stopped, and it is starting to look and feel like normal skin. I don't know what the hell it is, or where I got it, but it seems at least now to be going away.  The doc wants me on penicillin for 3 weeks, Cipro for a month, too long, IMO, I don't want to be on it that long because of the potential side effects that continue to show up after you stop taking it,  but we'll see how I feel after 3 weeks, might be safe to stop it then. 

My knee otherwise is painful, achy sometimes, really sharp, strong nerve pain sometimes, had shooting pains across my kneecap yesterday while driving to work that just took my breath away.  Once I got to work I took half a Norco and put an ice pack on it, that made it feel somewhat better.  I assume nerves are reconnecting and that's why things are so electric now.  Function wise, it's bending better and I should start PT on Monday. Right now both my knees are sore, so I feel a bit disabled and I walk like a 90 year old, I would like to think I am on the upswing but I don't like to assume, because you know what happens when you assume....