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Author Topic: Scar tissue strikes again?  (Read 72422 times)

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Offline Jaci

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Scar tissue strikes again?
« on: April 21, 2004, 08:18:45 AM »
Greetings,

This theme is becoming far too familiar. I seemed to be doing pretty well for the first few weeks. Then had a terrible flare-up of inflamation and swelling, and it's been downhill since.

The pain has reached the point where it is nearly unbearable and pretty much constant even with vicodin and arthrotec (anti-inflamatory). My PT has me on "active rest," which means no physical activity other than formal PT 3x per week. Even PT is very light.

My knee cap still seems to be sitting in the wrong place. There is a lot of pain in the lateral area, especially the femoral condyle. It feels like my patella is pushing and grating against it. Plus, terrible burning pain under my knee cap. It makes me sick to think that it's scar tissue again.

I really wanted to go back to work this week, at the very least I was hoping to work from home. Unfortunately, my employer won't let me do that. I worked from home quite a bit before my second surgery. Apparently my manager bent the rules a little in letting me do it because HR says it is strictly against company policy. If the pain doesn't make me crazy the boredom will.

I have PT on Weds and am hoping to see OS at the same time rather than waiting for my appointment next week.

I'm about a little over 7 weeks postop, is it too late to try the insuflation?

The pain is truly hideous. I just want it to stop...

Jaci
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline Heather M.

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Re: Scar tissue strikes again?
« Reply #1 on: April 22, 2004, 11:57:54 AM »
I sent you a private message, so check your inbox.

BTW, what are you doing at home on your non PT days?  I actually had PT every day, twice a day, in the formal clinic setting.  It was great, because I felt like we caught every potential problem before it became too big.  And my PT was able to reassure me, monitor my progress daily, and see the OS just about every day.  That was really nice.

At home, in between the two formal PT sessions, I had to do three more mini sessions.  These included patellar mobilizations, wall slides, SLR's, hamstring curls/stretches, icing, and elevating.  I was also in the CPM about 18-20 hours a day--even slept in it.  That made a huge difference in keeping the stiffness at bay.

The situation you describe--doing well for 1-2 weeks, then having a real flare of heat and swelling--is pretty typical in scar tissue cases.  That's when my OS usually breaks out the cortisone, SYNVISC, and broad-spectrum antibiotics.  I also used jobst treatments a lot, and these were fantastic for the pain and swelling.  My home TENS unit was helpful for waking my quad back up, forcing the swelling out of the quad, and numbing the pain.

How did your PT appointment go, and were you able to see the OS at the same time?  What did he say about a possible insufflation?

Let us know what's going on when you're able.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Jaci

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Re: Scar tissue strikes again?
« Reply #2 on: April 23, 2004, 02:22:27 AM »
Thanks, Heather.

Just got home from OS appt. He injected my knee with cortisone. Hit some scar tissue and had to move the needle around to find a better spot.  :o  Boy did I let out a yell. I almost passed out.  :o

Asked about the insufflation. He has not used the technique. We had a discussion about Dr. Steadman, being "the best of the best,"  testing new protocols. My OS has not seen any info in the journals about insufflation for knee arthrofibrosis, but would be willing to try it if I want to. He would do a closed manipulation at the same time. Just not sure if there is already too much scar tissue or if too well formed for it to do any good.

The inflamation flare-up started around the first week of April, I think the scar tissue bloom (I keep picturing scar tissue to be like the algal bloom that causes red tide  :-\) started around the same time. My ROM is still pretty good -5 extension/ 115 flexion.

Any thoughts or info from fellow KGs would be greatly appreciated.

Hope everyone is doing well. Thanks for your help.


Take care.

Jaci

PS-- OS is requesting a referral to a pain management Dr. Darn HMO  :-/ Gave me an Rx for amitriptyline to help with sleep in the meantime.
« Last Edit: September 06, 2005, 03:10:00 AM by Jaci »
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline Teresa_S

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Re: Scar tissue strikes again?
« Reply #3 on: April 23, 2004, 03:23:37 AM »
Hi, I am new to posting but did do an extensive chat this afternoon. I have been reading and researching arthrofibrosis and scar tissue formation for the last severalymonths, due to experincing this my self following a total knee replacement on 10-07-03. I had a closed maniplation and lysis of adhesions on 01-28-04, but due to the fact, the my OS ordered bedrest,and elevation rather than intensive PT, CPm and appropriate and adequate  pain relief, I naturally, developed new, and even more painful scar tissue, in big , hard, warm, swollen areas around and behind the knee. How I proy for more than 30 or 40 minutes of sleep at a time. The last time I saw my OS and begged him to do another lysis of adhesions, with a separate incision for the back of the knee, and use a lidocaine drip into the incision with a continuing epidural for pain control, followed by immediate, ongoing, intensive PT he told me"scar tissue formers just keep forming it." he then tried tochange the diagnosis to "reflex sympathetic dystrophy". If ever there is a diagnosis you don't WANT look up this. Unfortunately, I have been contacted by the doctors at the KNee and Shoulder institute, with more compassion than Ican get from my own OS, my insurance restricts me to certain physicians. I am at my wit's end. Appreciate finding this site, and any info. Thanks, Teresa
On going instrumentation failure, chronic infection,
Arthroscopes Left 11 Right 2, MRSA, L TKR  ,  Revision, LR x5, Medial and lateral meniscus repair, Broken prosthesis
Osteochondral Fracture,untreated 6 mths. Revision new tkr 01-07 awaiting new hip and right knee
R TKR pending

Offline Jaci

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Re: Scar tissue strikes again?
« Reply #4 on: April 23, 2004, 05:40:27 AM »
Hello, Teresa.

Welcome to the board. I'm so sorry for what you are going thru. The scar tissue and pain are bad enough, but throwing in an OS that's less than helpful can make the whole situation pretty overwhelming.

I started PT the day after surgery, used a CPM for six weeks, and did PT several times a day at home. My PT started the active rest about 10 days ago in response to an inflamation flare-up. Thought I had been over- doing my home PT, so wanted to give my knee a rest. So we did a lot of things right, but the more I read from Heather M, Laurie, Denise, and others, the more it appears that, while elements of the rehab protocol are the same, there is an art to selecting the best combination of elements for each patient. A commitment to mastering that art... it seems that's what sets Dr. Steadman apart from so many other OS.

I understand the difficlty of having limited choices due to one's medical plan. I started off with a different OS, but wasn't comfortable having him continue to treat my knee. I found out about my current OS from a physical therapist. He's outstanding, unfortunately he's not an arthrofibrosis specialist. Is there someone else in your medical group that you can see? At the very least can you get a referal to a pain management physician?

The insurance thing is a big challenge. Mine would only cover the CPM for 10 days, and only if I wasn't in formal PT. They wouldn't cover a pain pump or ice machine. I paid for them myself. Also, recently changed PTs. The HMO PTs were great, but not for this condition. So I'm paying cash for PT.

Anyway, at this point I'm just trying to figure out what to do. It's starting to look like I'll need more surgery. I will certainly consider going to see Dr. S in Vail. (One of my close friends is in Denver. She's called me nearly everyday since this ordeal started 7 months ago. Would love to see her while I'm there.)

Take care.

Jaci


« Last Edit: July 14, 2006, 04:17:08 AM by Jaci »
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline Teresa_S

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Re: Scar tissue strikes again?
« Reply #5 on: April 23, 2004, 09:39:01 AM »
I ,too, was having trouble with the insurance co. paying for the CPM, as thought I got it from the home health Dept. at our hometown hospital, and was being charged $48 daily through insurance, found out after the fact, that it was being sub contracted to a out of network provider. I stopped that and bought one on ebay for a mere $325.00 and now own it. It sure is easier than arguing with the ins. co. Pt is another problem as the good ones are not covered in this town, so, technically, I could go drive to another town, but the car takes its own toll on the knee. I got my orginal info on Arthrofibrosis from the knee and shoulder institute, and Cinc. Sports Med journal, but would like other sources to give to my OS, if somebody has any Thanks, Teresa  Will look forward to any answers
On going instrumentation failure, chronic infection,
Arthroscopes Left 11 Right 2, MRSA, L TKR  ,  Revision, LR x5, Medial and lateral meniscus repair, Broken prosthesis
Osteochondral Fracture,untreated 6 mths. Revision new tkr 01-07 awaiting new hip and right knee
R TKR pending

Offline Teresa_S

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Re: Scar tissue strikes again?
« Reply #6 on: April 23, 2004, 09:35:37 PM »
Hi again, I know it is a broken record where everyone recommends go to a specialist, but where are they? Are there any in the midwest, especially northeast Mo.? I live abourt 150 miles from Kansas City and 200 from St. Louis. Are there really Arthrofibrosis specialists, and where can I get a list to fight my insurance company? I am a fighter and have so far won all my battles with  the insurance co., but can not bully my way into physcians offices, once they ask the problem, and I mention my previous 10-14 scopes, and total knee, everybody tells me "you need to go back to the Dr who did the surgeries." Don't they realize that I would not be looking for somebody else if things were going well?!!!!!! I do think that giving advice that like "you have some of the symptoms of RSD, and Nerve entrapment, " and switching med every two weeks, allows them to feel like they did the surgery right, you just must have done something wrong. Or, you are a "scar tissue former and I can't stop that", is another cop out. My Os is so stubborn and self centered, that in a head on conversation he agrees with me, and says he'll do what I think is right, shows caring and concern, but never takes the time to get back to me. All the rejection , healing, time spent making and waiting for appointments, and multiple testing procedures adds to the duress of the situation. Add to that the lack of sleep due to severe pain, and exhaustion and you melt. I did notice alot of posting to this site takes place after midnight. So, since most of us are not at work, most of us must not be able to get a good night's sleep Take care. Teresa
On going instrumentation failure, chronic infection,
Arthroscopes Left 11 Right 2, MRSA, L TKR  ,  Revision, LR x5, Medial and lateral meniscus repair, Broken prosthesis
Osteochondral Fracture,untreated 6 mths. Revision new tkr 01-07 awaiting new hip and right knee
R TKR pending

Offline Jaci

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Re: Scar tissue strikes again?
« Reply #7 on: April 24, 2004, 07:07:12 AM »
Hello.

Something changed in my knee since my cortisone shot yesterday. As I was leaving my OS appt, I could feel something catch behind my kneecap. Then later in the day it really popped-- loud-- and my kneecap sort of jumped. I noticed today that it seems to be sitting in a more normal position rather than pulled down into the joint. Still not as elevated as my good one, but I can actually feel the outer edge of my kneecap. In general, the pain has eased up, especially tightness across the lateral retinaculum, but still a fair amount of burning and irritation behind the patella.

Today at PT my extension seemed better-- looser. Flexion really painful, my PT says that he thinks pain, rather than scar tissue, is stopping me from being able to bend more because he doesn't feel a 'hard stop.' I don't really know what that means. My former PT kept saying the same thing before my last surgery and there was a lot of scar tissue so I really don't know what to think.

I'm pretty confused right now. Maybe there really isn't tons of scar tissue forming again? Maybe I can just work through it with pain management and PT? Wait for a few weeks and see what happens. Maybe it's the lack of sleep? Maybe I'm under the influence of that denial medicine that Jennifer mentioned?  ???

Take care everyone. Hoping you have a good knee weekend.

Regards,

Jaci
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline Jaci

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Re: Scar tissue strikes again?
« Reply #8 on: April 24, 2004, 11:36:42 PM »
Well, there's definitely been a change and I don't know if it's for the better.

I woke up this morning to find that my leg, from above my knee all the way to my toes, is swollen. It's not huge, my toes look like sausages and my calf has that weird full feeling. I had a lot swelling like this after my first surgery, but haven't had it much with the second. Looks like I'll be spending the day elevating and icing.  :(

Take care, everyone.

Jaci
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline Heather M.

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Re: Scar tissue strikes again?
« Reply #9 on: April 25, 2004, 02:30:34 AM »
Jaci,

If you have a history of forming scar tissue, I really would be reluctant to take the opinion of a PT as to what is going on in there, unless that PT has a lot of experience with arthrofibrosis.  I say that just because knees with this condition simply don't act and respond the way 'normal' knees do, so I've found it's dangerous to generalize.  Not having a 'hard stop' in your flexion, for example, does not mean that you don't have scar tissue!  I have serious problems with scar tissue and the pain it causes, yet I have almost full ROM!  So there's not blockage of my flexion, but still significant problems being caused by scar tissue.  I can't bend my knee more than 30 degrees under load because I get sharp pain.  The pain is caused by the patella being pulled out of position by--ta-da!--scar tissue.  So while I understand that your PT is confused by the lack of a hard blockage of your ROM, it does not mean that pain is the only thing stopping you...i.e. implying that you could bend if you really wanted to.  And you have to ask yourself why it hurts.  

As for just working through the pain, if you do have arthrofibrosis you will find that to be pretty counterproductive.  That's because with the pain will come swelling, heat, and the inflammatory response that you want to avoid more than anything, as it will produce more scar tissue!  My OS's rule was to do NOTHING that caused appreciable spikes in my pain levels.  Laurie did this, and so her return to strength training was delayed by over a year.  She was lucky in that her mechanical issues were resolved by the scope to remove scar tissue; my knee had permanent mechanical changes from being improperly treated for so long...part of that treatment involved working through the pain with aggressive PT.

One of the best reasons to find an arthrofibrosis specialist is that they usually work with PT's who are equally knowledgable about this problem.

Heather
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline Jaci

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Re: Scar tissue strikes again?
« Reply #10 on: April 25, 2004, 05:16:46 AM »
Heather,

Thanks for the reminder and dose of reality.

I think I just need to be in denial for the rest of the weekend. On Monday I'll let it sink in that my OS couldn't get a needle through the scar tissue that has already formed in my knee.  :P I'll figure out what actions I need to take to get myself to Dr. S or some other arthrofibrosis specialist. Are there any in Southern CA?

My current OS and PT have done so many things right. My PT keeps reminding me that with my knee doing more is not better. But, I think the key is getting the inflamation under control quickly with antibiotics, cortisone, etc. and using a technique like insufflation to break up the adhesions before they become too thick.

Scar tissue is nasty stuff!!!

On a positive note, I think I've been reading my company's short-term disability policy incorrectly. I think they will pay my full salary for up to 52 weeks, not just the three months that I thought. If that's the case, this takes a huge burden off my shoulders, especially if I need more surgery and rehab. I'll talk to someone in HR on Monday to find out.

I think it's time for ice and a little of the universal remedy-- chocolate!!  ;D

Regards,

Jaci
10/03 Twist injury
12/03 Menisectomy- tears ACL, MCL, & LCL missed by OS
Arthrofibrosis ROM 38-68
3/04- 4/08 Multiple scar tissue procedures:
6 scopes w/LOA, AIR, LR, chondroplasty, synovectomy, bone spur & plica removal
3 insufflations, many injections
Chronic AF, patella infera, IPCS

Offline Heather M.

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Re: Scar tissue strikes again?
« Reply #11 on: April 25, 2004, 06:35:36 AM »
Jaci,

I understand absolutely the benefits of denial as a plan of action!  As long as that denial involves resting and keeping the knee up, it's really not a bad policy...for short periods of time.  That's because you're still early enough in your rehab and general knee situation to still be able to positively affect the way things go.  So you take as much time as you need to deal with this low, cruel, rotten blow that life has dealt you.  

As for the ice, followed by chocolate...I did you one better...I had chocolate ice cream!  Okay, it went in my mouth, not on my knee, but I still think the principle applies.... ;D

And that's fantastic news about your disability policy!  Sometimes the thing you most need in a situation like this is time, with as little pressure and stress as possible.  It's good to know finances won't drive you back to work prematurel.

I'm not sure if Dr. S. has a former fellow in So. Cal., but I think the chances are probably excellent.  None of the real arthrofibrosis specialists I've found are there, however.  The way I found them--and there was no nation-wide list or database to consult--was to look up all the medical journal articles on arthrofibrosis that I could find.  Then I looked up the authors of those articles online and located them.  For the most part they are in MI, OH, CO, PA/NY, and UT.  That may be the closest one to you--Dr. Paulos is in Salt Lake City.  I believe he was in Las Vegas for a few days a week, but I'm not sure if those hospital priveleges stand because he changed practices to one closer to Park City in UT and that changed the setup.  I think Jennifer123 contacted his office, so you may want to talk to her.  

The fellow who did my surgery in conjunction with Dr. S. is in So. Cal. (Irvine), but he may have gone on to another fellowship or whatever.  I don't really know how to locate him, and to be honest...I'd take Dr. S's 40+ years of experience working with knees any day.  He's got to be about 72, more physically fit and active than I am at 34, and he just radiates this quiet competence and confidence.  He's one of the top knee surgeons in the world, but I had no trouble talking to him at all.  He never got offended when I brought up tough questions and he didn't ever pat me on the head.  In fact, once he realized that I'd done a lot of research, he had a conversation with me that used words that had his fellow scratching his head...and I understood.  So he just has a great bedside manner.  I would definitely call his office and see who he would recommend in So. Cal.  

I also know that Heather K. has a surgeon she loves in Torrance.  But she's not seeing him any more because she had so many post-op issues with infection, wound closure, and scarring that she thinks she might have run him off ;D  Still, he seemed wonderful, and it might be worth contacting him.  I can IM you his name.

Take care, and take the weekend off!

Heather

PS I also have trouble with scar tissue that defies needles...in fact, my acupuncturist (she's an MD as well) said I was bending the needles last time. :-/
Scope #1: LR, part. menisectomy w/cyst, chondroplasty
#2-#5: Lysis of adhesions/scar tissue, AIR, patellar tendon debridement, infections, MUA, insufflation
#6: IT band release / Z-Plasty, synovectomy, LOA/AIR, chondroplasty
2006 Arthrofibrosis, patella baja
http://www.flickr.com/photos/hmaxwell

Offline jennifer123

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Re: Scar tissue strikes again?
« Reply #12 on: April 25, 2004, 08:18:13 AM »

I also was seeing Heather K's doctor... he was really good at
identifying parts of my knee that hurt and why they hurt - but he
missed the scar tissue diagnosis that Dr. S. made.  However, I
was still thinking that if some of my post-op care could be
transfered to California, this doctor would be my first choice
because he's very attentive to his patients.... and also, he
identified many things that I was doing in daily activities that
was probably further irritating my patella tendon.  Before I
began seeing him, I was probably at an 8-9 constant pain
level.  After I took his advice the pain dropped to about a 7.
I know this doesn't sound like a big deal, but it was and is to me.
Other doctors I had seen never once offered any suggestions.

Jennifer
« Last Edit: April 25, 2004, 08:18:38 AM by jennifer123 »
8 surgeries:
2/03 ACL left knee
5/03 LR right knee
6/03,1/04 scar tissue removal left knee
5/04, 6/04 adhesion removal, anterior interval release;  8/04 MUA, insufflation, injection; 8/1/08 ACL left knee (again) + LOA

Offline Teresa_S

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Re: Scar tissue strikes again?
« Reply #13 on: April 25, 2004, 07:19:58 PM »
Hi, I have a question for any one who might have a suggestion. As I lay awake again last night, praying for sleep I realized I had never asked if anyone had the following problem also. When the pain awakens me, my knee (leg/s) are so HEAVY. they feel like they do when you say"my foot went to sleep,a nd then you get that tingling pain .  I ususally have to physically take my hands and turn over the leg, and rearrange it. If I don't and it falls to the side of the bed, or over to walk before I realize it, I seem to walk over it, and the foot stays is place and my body moves forward, resulting in a fall if there is nothing to grab unto . The knee feels even heavier than it did when it was first replaced. Right after my total knee I accused my surgeon of putting in a 75 lb. knee, and his nurse said "everyone says that until they get used to it. " I realize that the heaviness also happens to my other leg at night. If I am on my side, the increased pressure of just the top of the leg against the bottom of the leg increases the pain 10 fold. I do also have a herniated disc through the annulus at L4 L5 and have often wondered if it is the disc of the knee. Sometimes I am awakened with pain and the leg itself including the foot is numb and heavy. Itold my OS  this is often preferable to more pain.  I really am so exhausted, that I find my self drifting off even sitting at the computer, or anywhere I might sit down. I have to keep up and moving.  The big rope like fibrous tissue above my knee is now much bigger and can be seen by people I', walking towards. I do think that because of pain we all develop a different way of stepping and bearing weight on the joint that relieves it to the point we can by doing that, and that  variation leads to further hip , back, and other leg/knee problems. My other knee needs to be replaced due to degeneration, and all the literature says not to let it get to the point of my one that was done and the recovery will be much easier, but I just can't think about that , and am wearing a brace to try to buy a few years, if possible,. although it, too was scoped last year, and I have no cartilage left, and have developed scar tissue causing some pain but none to compare to the left. If anyone has or doesn't have the heaviness I would be interested, as I am preparing my own private list of what personally fits the description of diagnosis, as what is "in additon to" I feel for anyone with this pain and the decisions, fear, depression and sometimes denial. When I was pregnant the last time they told me I was developting gestational diabetes, and I told my  ob "I refuse", he said "you can't" and I said watch me and made it through without any additional symptoms or rise in blood sugars. I, also , absolutely can not have a condition in my life that so completely dominates it as this one does from movement to what you can or can't accomplist due to pain, to the extensive time it takes to rehab it daily. This is not true denial, but more of the "mind over matter" everyone seems to think can "help us tolerate pain" Although the pain doesn't increase, and I do get more things done I have to wonder what further damage I do when I ignore the pain, warmth, swelling, and accomplish the task. Thanks to everyone, Teresa
On going instrumentation failure, chronic infection,
Arthroscopes Left 11 Right 2, MRSA, L TKR  ,  Revision, LR x5, Medial and lateral meniscus repair, Broken prosthesis
Osteochondral Fracture,untreated 6 mths. Revision new tkr 01-07 awaiting new hip and right knee
R TKR pending

Offline Jan_L.

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Re: Scar tissue strikes again?
« Reply #14 on: April 26, 2004, 07:52:32 AM »
Hi Teresa,

I had my TKR on Dec. 4th, and I have never had a heavy sensation or a tingling sensation in my legs.

After months of not being able to sleep my internist prescribed sleeping pills for me.   It felt so good to finally get a good nights sleep.   I only take it once or twice a week.  Have you tried medication to help you sleep?

Jan

1985 - auto accident- both knee went thur the dash.
1985 - 1990 Four scopes left knee
2002 - Fulkerson TTT
2003 - Scope Rt knee
2003 - Right  TKR
2003 - MUA, 2004 - MUA
2005 - Right TKR  revision
2006 TKR - left knee, 2 MUA
2007 2nd TKR  revision - Rt knee