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Chronic Pain
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Angelic_Victory
Veteran Member
Joined : Sep 2012
Posts : 2138
Posted 9/24/2016 9:08 AM (GMT -7)
I'm getting ready for my first appointment back with my pm dr since having surgery to remove my knee caps. My legs are significantly weaker and there's a lot of pain. My right knee is bone on bone and the left has stayed swollen since surgery and both knees are prone to hyperextension (incredibly painful). Up until the surgeries I was managing well on a low dose of Norco twice a day. Now that doesn't begin to put a dent in it. How do I relate this to him? I don't want him to think I just want more drugs but I do want the pain managed so I can have a life. I don't feel like he always listens to me.
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straydog
Forum Moderator
Joined : Feb 2003
Posts : 18322
Posted 9/24/2016 2:34 PM (GMT -7)
I suggest making a list of the problems you are having since surgery & also a list of things you are no longer able to do & how it is affecting your quality of life. I know what you mean about being concerned what the dr may think. These days its not so much what the drs think as it is the guidelines the drs go by when treating a chronic pain patient. Its not a very good or lenient environment any longer.

By being prepared for the visit with a list you have a better chance of getting him to listen to you. Take care.
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White Beard
Forum Moderator
Joined : Feb 2009
Posts : 3740
Posted 9/24/2016 8:10 PM (GMT -7)
Hi Angelic Victory just be honest with your PM, tell him how bad you hurt, and when it is worse or better, and what affects it, and ask him if there is anything he can do to make the pain more manageable. Don't ask for more or stronger medications, just ask him to help you better manage your pain. Let him or her know your problem and situation, and then let him decide what can be done to treat it. Allot of doctors don't like to be told by their patients on how to treat them, so you are better off, just letting them know what is bothering you, and then ask them to help you. Most doctors are more receptive to this approach, and your more likely to get better treatment. It is not always the case, but I have found it works allot better than allot of other ways.

I wish you all the best, and of course keep us posted on how you make out at your appointment.

Good Luck to YOU!

White Beard
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Angelic_Victory
Veteran Member
Joined : Sep 2012
Posts : 2138
Posted 9/24/2016 8:28 PM (GMT -7)
I am planning to see if he can help set me up with more pt. I want to try and build some muscle around my knees but with how unstable they are I'm not sure how to go about it. One local clinic offers pool therapy so I'm going to ask about it. I'm allergic to the steroids they use in the injections and can't take nsaids so I'm going to ask about other options to help swelling. I really would rather find ways of managing without the meds. My surgeon wasn't helpful. This isn't a common surgery and he says I've already exceeded his expectations. I have full mobility but fall often and it's very hard to get back up. The surgeon said to just always use my walker. It seems like there should be other options. I'm not ready to limit myself. I'm hoping the pm dr gets this but in the past he seemed more interested in trying different steroid mixes to see if I could tolerate them (lots of trips to the er later and I don't want that again). I'm afraid if I say no more injections that he won't help at all.
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White Beard
Forum Moderator
Joined : Feb 2009
Posts : 3740
Posted 9/25/2016 2:13 PM (GMT -7)
Angelic_Victory since you said your right knee is bone on bone, wouldn't that make you a good candidate for a total knee replacement? And might that not be better in the long run for you? Just wondering why that wasn't done in the first place. My sister had total knee replacements done on both her knees, and she has excellent mobility and can do just about everything. I've also had a total knee replacement done on my right knee, and although it took me allot longer to recover and get the swelling down, but with extra physical therapy, I have finally got really good range of motion without pain in it now!

Anyway I was just curious as to why they done that type of surgery verses the total knee replacement?

I do wish you well and hope things work out for you!

White Beard
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Sometimes i am me (HT)...
Elite Member
Joined : Mar 2009
Posts : 22134
Posted 9/25/2016 4:59 PM (GMT -7)
sending healing thoughts to you. you will have more stability with the walker. keep strong.
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(Seashell)
Veteran Member
Joined : Dec 2012
Posts : 1080
Posted 9/25/2016 5:37 PM (GMT -7)
Angelic:
Working with your pain mgm physician on a referral to a sports-medicine physical therapist seems like a strong idea to work towards in your upcoming visit.

The patella (aka "knee cap") is a small sesamoid bone that lies in the tendon of the quadriceps muscle. The patella provides mechanical leverage to the quadriceps muscle, enhancing the efficiency and strength of the quadriceps. That is, the patella places the quadriceps in an angle such that the physics of the quadriceps muscle is improved and enhanced.

People without a patella report similar symptoms and complaints that you have. Instability of the knee, pain, swelling/inflammation. The knee, as a hinge joint, relies solely on the muscles and ligaments that surround the joint. There is inherently no bony stability to the knee joint as there is bony stability to the hip joint, for example. The knee joint depends on muscular strength of the quadriceps (anteriorly) and hamstrings (posteriorly), as well as the anterior and posterior cruciate ligaments and medial and lateral collateral ligaments.

That you are hyperextending the knee is likely due to muscular weakness. Hyperextension of the knee, repeatedly, causes ligamentous laxity that then promotes continued hyperextension. The hyperextension problem increases - in both frequency and in the degree of displacement of the femur in relation to a fixed tibia.

It could well be that your knee pain (bone pain), swelling, and cases of hyperextension would ease given attention to a monitored and graded program with a sport-medicine minded physical therapist.

This is not to say that you should not pose the need for pain management support . . . you should be discussing your needs for pain control with your pain management physician.

But I am suggesting that surgical removal of the patella does dictate the need for a focused physical therapy program. The quadriceps muscles is at a mechanical disadvantage without a patella. Muscle re-education and strengthening is vital for the knee after resection of the patella. Little wonder that you knee is sore, hyperextending, and swollen.

While your pain management MD can ameliorate your pain in the short-term, the long-term management will entail a qualified physical therapist that will strongly work 1:1 in partnership with you.

I am a physical therapist by profession and would be happy to query any concerns/questions that you may have of any PT who works with you. As with any profession, there are good physical therapists and less than good physical therapists. Trust your instinct. If a PT is not a good fit for you or if the sessions and advice just feels "off," look elsewhere until you find a PT that you feel comfortable with and who is skilled in the skill set that you need.
- Karen -
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(Seashell)
Veteran Member
Joined : Dec 2012
Posts : 1080
Posted 9/25/2016 5:52 PM (GMT -7)
One other suggestion for control of pain and swelling . . . .

The use of a compressive wrap with cold therapy (cryotherapy) would be of therapeutic value for your post-surgical knees and, quite frankly, I am surprised that your orthopedic surgeon did not provide you with a home cryotherapy unit. Take-home, portable cryotherapy units are routinely given to post-surgical knee patients (for post-surgical ACL reconstruction, post-surgical arthroscopic menisectomies, and post-surgical TKRs). Shame on your orthopedist for leaving you in the lurch.

You want a compressive sleeve that provides cold therapy/cryotherapy.

I just spent a few minutes on Amazon and saw 2 or 3 appropriate options. There is a Aircast® compressive knee wrap with cryotherapy as well as a ColdCase® compressive knee wrap with cryotherapy. The compressive sleeves are typically made of neoprene or lycra. The cold therapy is often a re-freezable gel insert that fits into a pouch on the compressive wrap OR a battery-generated unit that circulates chilled water through small water-filled cells in a compressive neoprene or lycra wrap. The costs were $50 to $125.

You can also inquire a local durable medical equipment provider for a cryotherapy unit for your knee. The rental should be provided by your medical insurance with prescription by your original orthopedist.

- Karen -
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Angelic_Victory
Veteran Member
Joined : Sep 2012
Posts : 2138
Posted 9/29/2016 7:01 PM (GMT -7)
My kneecaps were underdeveloped and constantly dislocating. They were damaging the bones around my joint. I'm in my early thirties so my dr didn't want to do a tkr at this point. I will be having them but he would like to wait 10 years or so.
I do use ice packs and wraps on my knees. I have a few different braces and the ice us the best way to treat the swelling. I can't take nsaids. I'm seeing my pain management dr on Monday. I'm definitely going to request the pt. I'd love guidance on the best ways to build muscle. I'm at a loss. I have a tens unit that I got after the first surgery because my quad wasn't firing for a while. I'm unsure what is considered safe. I've had a few falls and it's so hard to get out of the floor. My surgeon just continues to say I've exceeded his expectations, which isn't helpful. I'd just like to be as mobile as possible. I'm a single mom with 2 ****s. I know I will have limitations but I'd like to do as much as I can. I'm not afraid of pain but I need it managed so I can continue being the mom the kids need. Thank you so much. The wraps you looked at, would they be able to be worn while moving around the house? Right now I have to sit down to Ice.
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