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Kender

What is wrong with doctors.

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I am convinced more everyday that most DRs are too hung up on fixing a part that they forget about the human connected to it.

Short recap on my story, long version is in intro forum. 4 failed surgeries in 4 years, the last one is a knee replacement that failed within 6 months. It is the knee replacement failure that I am currently dealing with. I have a history of MRSA and vascular damage in the same leg. 3 phase bone scan and WBC scan indicate infection. My symptoms indicate infection. The x-rays show bone loss below the tibial plate. The DR took fluid out of my knee and the culture came back negative for infection. Because of the negative culture the DR thinks that the cement holding the tibial plate come loose just needs to be replaced but to be sure he will scrape the bone/metal for a culture while I am in surgery to clean out the knee and replace the cement. In all my research everything to do with the scans and cultures for infection state that you must stop all antibiotics 10-14 days before the scan or the bacteria could be suppressed and give a false negative.

What my DR does not know is that if my knee is infected I am going to have an AKA/disartic because of my infectious history and vascular issues......but this has no bearing on the way the DR is behaving.

Now for the recent WTF moment. My surgery is this coming monday so I went in for my preop registration at the hospital. Today I get the results from 2 tests they did. The nasal swab is positive for MRSA and I have a urinary tract infection (UTI). If you have an infection they won't operate so the DR prescribes an ointment to put in my nose, special antibiotic soap for my skin, and oral antibiotics. They still want to keep the surgery date the same. My concern is that the oral antibiotics will give a false negative on the bone/metal culture. So I let the DR know of my concern and he says that this antibiotic should not affect the knee infection if it is actually infected. Well since I don't trust a DR to care about me as much as I care about me my first stop was the internet. Looking up this antibiotic I find out that it is used to treat a lot of different type of infections...........including bone/joint infections. WTF!!!!!!!!!!!!! Is this guy actually trying to cause me problems? If I take the pills and the culture comes back negative there are 2 possible outcomes. Either the knee never was infected and the failure was due to something else or my knee really was infected. In the case that it really was infected and the negative culture was false the DR won't do the necessary procedure to clean it out, cut away the infected bone, and use antibiotic spacers. What this means for me is that a few months after this surgery the infected bone re-infects the prosthetic joint and starts to eat away at the cement and bone again, putting me in the exact same position as I am right now.

I don't get it. How is the DR not putting together the puzzle...UTI, MRSA, Possible infected knee, and he is prescribing a medicine that he doesn't even know is going to screw up the test results that he is supposed to be looking for. I can't believe the DR is so focused on fixing the knee that he is ignoring the body that it is attached to.

End rant.

Thanks

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Drs are trained to SAVE. That isn't always the best outcome. They could save my foot, but it would be totally useless. I chose amputation. Most people thought that was extreme. For me, it beat using crutches and/or a brace of some kind the rest of my life. Luckily my Dr agreed with me that this would produce the best outcome. I have never regretted my decision.

I should also say that another reason I chose amputation was to avoid possible infection during the numerous surgeries they were considering over the ensuing year.

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Hi Kender,

Yes, they are trained to save things. Some would say that is a good thing, the problem is when they never give up trying :rolleyes:

It sounds like your Dr either isn't listening to you or isn't explaining things to you very well or allaying your fears.

Why don't you ask for a second opinion, you do not have to have the operation until you are sure about it.

Cement failure is quite common, it does not necessarily mean that there is an infection but understand with your history why you are worried.

I had 30 surgeries prior to aka, three failed knee replacements included and a knee fusion, it was only when there were no other options that I agreed to the amputation. I know I am unique as an amputee but there are days when I wished that I had never had the amputation.

I also had MRSA lots of times, it is only problematic when it gets into an open wound. Lots of people in general society carry the bug in their nose and don't even know that they have it. They operate on lots of people who carry the bug in their nose, they just have to be more careful.

Guess what I am trying to say is take your time with the decision, with either opinion, get another opinion and make sure all your fears are addressed. Then make your mind up.

Good luck.

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Hi Kender,

Yes, they are trained to save things. Some would say that is a good thing, the problem is when they never give up trying :rolleyes:

It sounds like your Dr either isn't listening to you or isn't explaining things to you very well or allaying your fears.

Why don't you ask for a second opinion, you do not have to have the operation until you are sure about it.

Cement failure is quite common, it does not necessarily mean that there is an infection but understand with your history why you are worried.

I had 30 surgeries prior to aka, three failed knee replacements included and a knee fusion, it was only when there were no other options that I agreed to the amputation. I know I am unique as an amputee but there are days when I wished that I had never had the amputation.

I also had MRSA lots of times, it is only problematic when it gets into an open wound. Lots of people in general society carry the bug in their nose and don't even know that they have it. They operate on lots of people who carry the bug in their nose, they just have to be more careful.

Guess what I am trying to say is take your time with the decision, with either opinion, get another opinion and make sure all your fears are addressed. Then make your mind up.

Good luck.

The second opinion is a touchy thing since this is all under workers comp and they won't approve a second opinion. I understand that cement failure isn't uncommon but I think that it failing with in the first 6 months is uncommon. If it is a simple cement failure and not infection that's great but I need to have no doubt that it is in fact not infected so that if the cement fails again prematurely I know to look at a possible rejection scenario. I have battled MRSA for about 5 years now and have had the boils and pimple type infections so I know I am not simply a carrier. This is why I am convinced that I have an infection in my knee. I have been in constant pain for so long that I am not about to postpone the surgery if I don't have to.

Your story of multiple surgeries and failed attempts at salvaging the limb is exactly why I know that amputation is the right choice for me if the knee is infected. Since I have already had some failed surgeries I know I have tried. I am 31 with 2 kids under the age of 4. If it is infection I know that the next 10-15 years will be a long series of surgeries that will ultimately end in amputation anyway. I am not going to miss out on my kids childhood because I was either in pain from the latest infection or from the most recent attempt at physical therapy. I want to cut to the chase, so to speak, while I am young enough to bounce back from it and my kids are young enough that what they will remember of dad is that I was active in their life.....not laid up lame on the couch high on pain killers.

It wasn't easy making the decision, at first I couldn't even wrap my mind around the thought. The more I researched and logically evaluated my situation the more I cam to except that it would be the best course of action. I am sure that there will be days that I will look back and wish I still had my bio leg but like any "elective" surgery (non-life threatening) there will always be that "what if". Luckily for me my logic steps up and says "well your stuck now, you can't change it, so look at the up side and make the best of it." I did this with my teeth when I had a horrible infection and could either salvage with several procedures and over $10k out of pocket OR yank them and use dentures. My quality of life is so much better now than before so I know the decision was right.....for me.

Thanks for the input, I don't want it to seem like I am shooting down any of your help. It's hard to list everything that I have done or thought of through the keyboard so I try to hit the main points. I'm sure everyone knows what I mean.

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Drs are trained to SAVE. That isn't always the best outcome. They could save my foot, but it would be totally useless. I chose amputation. Most people thought that was extreme. For me, it beat using crutches and/or a brace of some kind the rest of my life. Luckily my Dr agreed with me that this would produce the best outcome. I have never regretted my decision.

I should also say that another reason I chose amputation was to avoid possible infection during the numerous surgeries they were considering over the ensuing year.

I will have a long talk with my DR if it is infected. I will try to relate to him the quality of life issue and make him realize that the human side of the equation is suffering because of this damaged limb. Even if I don't convince him that I will be better off at least I can show him that I have given it a lot of thought and this isn't just a whimsical decision. I would also like to avoid the MRSA digging in deeper and making it's way to a vital organ/system. Like you I have a fear that each surgery will increase the possibility of this happening.

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Hi Kender,

No offence taken at all.

Believe me I really do know where you are coming from.

I now see that you clearly know what you want.

Why does your Dr not know that you are considering amputation if the knee is infected? Perhaps if he finds it infected he could amputate it instead as that is your elective choice. Perhaps if you told him this he could fully appreciate that you have had enough of the pain and you are not willing to put yourself or your family through further unnecessary surgery. He may begin to understand that you have really thought this through and see your concerns about all the infection stuff as genuine. Drs often dismiss a patients concerns as they think it is natural for patients to be worried prior to any surgical procedure.. You have to get him to address your concerns.

Good luck with it all.

Keep us posted.

Lynne

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Hi Kender,

No offence taken at all.

Believe me I really do know where you are coming from.

I now see that you clearly know what you want.

Why does your Dr not know that you are considering amputation if the knee is infected? Perhaps if he finds it infected he could amputate it instead as that is your elective choice. Perhaps if you told him this he could fully appreciate that you have had enough of the pain and you are not willing to put yourself or your family through further unnecessary surgery. He may begin to understand that you have really thought this through and see your concerns about all the infection stuff as genuine. Drs often dismiss a patients concerns as they think it is natural for patients to be worried prior to any surgical procedure.. You have to get him to address your concerns.

Good luck with it all.

Keep us posted.

Lynne

There are a few reasons I haven't brought up amputation with this DR. Most of my interaction with him is actually through his physicians assistant. So I don't think my concerns are being conveyed to the actual DR. Whether you see the DR or the PA is pretty random, except for "serious" cases. Also the DR. is extremely certain that this is a simple cement issue so bringing up amputation will result in the typical DR. answer of "oh it's too early to even think about that". I do realize that the DR. may be putting on a false confidence so that I don't worry and that I expect the best possible outcome. Since it is workers comp he would have to get a separate authorization for the amp I would have to do another surgery anyway.....plus I don't know if I would have him do it since I want an Ertl. If I wake up to find that it is infected then I will have him take a seat while I let him know what I want and why. At that point I will find out if he even does amputations. If he does amps then I will confirm that his treatment of arteries, muscle, bone, and nerves is the same as Ertl. I will also then evaluate if I can even do a disarticulation or if the AK would be better. This is what is driving me nuts, it could be as simple as the original cement failing and it's just a 1 in 1000000000 chance that it happened to me.........or it could be the infection in which case the amputation comes into play. I am in limbo standing on the edge of a major life changing event or a simple knee surgery. I'm pulling my hair out not knowing and that's hard since I shave my head. It's kinda funny, my birthday is on the 26th just 2 days after the surgery and I couldn't care less about my B-day. What I am looking forward to is the surgery, well the answers that the surgery will bring.

Thanks

DJ

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