In Shock and Upset after 6 week post op visit!

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Ok, I apologize in advance, because as I'm writing this I'm in a ton of pain and still upset about my Ortho visit yesterday, so please bear with me.

I had a trimalleolar fx w/dislocation (my L foot was backwards) Sept 12th 2016. I was sedated whilst they reduced it back and I was told I would never walk on it without ORIF. I had to wait 17 days for the ORIF surgery due to swelling. On surgery day, right before surgery I was given a popliteal nerve block with a pump attached. I was told the nerve block would last me a few days as far as keeping me nice and numb and comfortable.

It lasted 5 days, and when I told the anesthesiologist that called me daily to check on me that I was still numb, he said go ahead and remove the nerve block wire. I thought the fact that I was still numb was normal. The entire last 6 weeks has been horrible, with my 4th toe and pinky toe and outside of my foot 100% numb but also in pain, which feels like someone holding a flame near my toes and foot. The outside of my foot is numb as is the bottom of my foot. You know that feeling when you break out in chills all over? I've had that feeling constantly but only in my left leg from the knee down. It's been excruciating and the first time I called the nurse to tell her about it, about 10 days after surgery, she said oh it's just your toes, the surgeon isn't going to do anything about that..... hmmm... so that got me upset and I had read about Gabapentin helping with nerve pain. Being a Medical Assistant myself, I requested Gabapentin and she conceded and said she'd ask the doctor. I got 100mg 3x a day and Tylenol for the pain. It wasn't doing much but it was taking the edge off. The next week I called and asked for an increase and now am taking 300mg 3x a day.

So yesterday I went to my 6 week post op appt. First thing they did was take off my cast and send me to xray. I have been on zero weight bearing but had accidentally put weight on my foot a week ago and have been in a lot of pain.

After the xray I went back and waited to see the surgeon. It wasn't my usual surgeon but someone else which I didn't really mind. But I was here with a lot of questions and concerns, and before I could talk about them he said 3 sentences... xrays look fine and we'll see you back in another 6 weeks, and a guy will come in and give you a boot.. then he walked out of the exam room. I was in shock and speechless. When the Medical Assistant came in with a large airboot and saw my tiny feet he proceeded to use that one. I said hello, my foot is very small, isn't that a large? He stopped and said yes, I guess I'll go exchange this for a small.. he didn't look too happy about it. When he came back I asked if the surgeon was coming back in as I had a lot of concerns and questions... I was told no. This is where my anger really comes in.. I insisted he call the surgeon back in!

So this surgeon, who had come in earlier with his 3 sentences, comes back in and sits down and looking very irritated, asks me what I need to say....

I said first of all my pain level is an 8.. I reinjured my foot a week ago by putting too much weight on it and he said... "ankles are fickle and wax and wane, you're fine." I said hmm.. well I'm in a lot of pain and let me show you what's going on. He never once touched my ankle to exam me so I showed him which toes are 100% numb and how the outside of my foot was mostly numb, including the bottom of my foot and partial numbness all the way up my calf. I showed him I couldn't move my ankle AT ALL. I told him about the shooting pain and the fact that the Gabapentin and Tylenol and my OTC Aspercreme w/lidocaine wasn't working and I was spending my nights unable to even let the sheets or blanket touch my toes. His response was that I should call the anesthesiology dept and tell them as the nerve block may have damaged some nerves, causing my pain and numbness from the knee down and that if this is the case then I am looking at least 10 months recovery. He also said he'd refer me to a Neurologist at my next 6 week appt if I was still having nerve pain issues. When I asked for pain medicine he said they don't prescribe anything for pain, only for the 1st week after the original surgery. I said I reinjured it and my pain was at an 8 and so he said all he could do was increase my Gabapentin to 400mg 3x a day and then left the room. The Medical Assistant came back in and I said umm... I have been zero weight bearing up until today.. what are my instructions with this new airboot? What am I supposed to be doing the next 6 weeks? How much weight should I be bearing and for how long? What about Physical Therapy? So he went and asked the surgeon all these questions and returned and said this.... the surgeon said do what you want when you want and you decide what to do... and no physical therapy needed. I said well from everything I've read, patients are usually given PT and not only for the foot but the whole leg due to atrophy. I also said that with my nerve damage and severe pain, that I had read that early intervention could greatly help me with that.. so I sent him back again with a firm request for PT.. he returned and said no, the surgeon didn't feel it was needed and reminded me to call the anesthesiology dept.

So here I am with an airboot on, with no instructions, my knee scooter, and me in tears thinking ok, I need to become my own doctor now and go home, and research and ask what I should be doing for the next 6 weeks. I did a quick try of putting some slight weight on my foot and it was a definite no go.. too much pain! I guess I am just wondering what happened with those of you who had a trimalleolar fx w/dislocation and ORIF at your 6 week follow up? Any advice would be greatly appreciated. I took the airboot off last night when I went to bed and was in too much pain to sleep so had to put it back on. It's heavier than my fiberglass cast and awful to sleep in. So yes... any advice would be greatly appreciated!!

Thanks,

Cheryl

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8 Replies

  • Posted

    OMG!  Cheryl, I feel so bad for you.  I don't have any experience with what you're going through in that paticular injury, but after reading your story, my heart was breaking for you.  I want to give you a virtual hug.  ((((((((Hug)))))))  I am sure you'll get some other responses, but I could not just read your story, without commenting.  I am so sorry for what you're going through (and not just physically, but mentally and emotionally) and what you've been going through. 

    ?Thinking of you and I hope somehow, someway, you can get some help.  sad

    Beth

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  • Posted

    Oh my how horrible I thought I was mistreated because I had no medical insurance st the time of my accident. I'm so sorry sounds like you need another opinion please hang in there and go get another opinion I know your pain my injuries are different but I know how painful this is please keep me posted I'm here to talk to good luck

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  • Posted

    Hi. I am so sorry for your experience. I had the same injury. I left surgery in a splint. At my 3 week appointment post surgery, I got an x ray and a cast, at my 6 week appointment I got an x ray, air cast (boot) and physical therapy started. At my 12 week appointment I was released from the boot and am now fully weight bearing and learning how to walk. I traded my crutches for a cane yesterday, but my ankle is still extremely stiff and it's definitely a long road still ahead. I can't imagine doing this without PT and I'm so sorry that your surgeon doesn't think it's necessary. I was cut off from pain killers after 2 weeks; pain management after that was extremely challenging. Can you get a second opinion regarding PT? 

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  • Posted

    hiya,can i ask what country do you come from,because where ever it is i would leave it as soon as if that stheir health system,bloody hell.my heart goes out to you as i dislocated my left ankle about 13 years ago and eneded up having it fused 3 years ago because of arthritis setting in,my foot popped out of the socket and was up inside my left shin,(i tell you, it ruined my ballet career),i ended up being rushed to hospital by ambulance and left in A&E for 9 hours without painkillers,all they did was pull it back into position and left me there,i finished 2 canisters of gas and air in about half hour and then that was it,9 hours of hell,to my astonishment a doctor walked past and saw me and asked a nurse what time i had got there,she said about 9 and a quarter hours ago,and youll never guess what he said,he said "my god,you do realise that if hes left there for another 15 minutes he could sue this hospital".apparently nine and three quarter hours is acceptable for a patient thats been through intense trauma to sit there for.f*&k me sideways,that was just the begining of my nightmare untill i got home and was able to get comfortable,as you can imagine that was just the begining at that place it got a lot worse from there but there isnt enough time in the day to tell you the rest.my point is i know how bad some doctors can be and the only way to get what you need is to be ruthless,do not give any quarter and demand things like a spoilt rich person because if you dont you wont get anywhere,this is very important to you and shouldnt be taken lightly,incase you hadnt guessed im from the uk,so even though we have the NHS it doesnt mean we get the best treatment all the time,the NHS is like most things,sometimes good sometimes bad,anyway my advice is to get legal advice and also change the d*ckhead you saw last time,christ they gave people pain relief in tents in the middle of a poxy battle ground in the first world war for christ sake,you would have thought nowadays that it should be easy,one thing i do know is no one should suffer for no reason and my heart goes out to you,good luck and will be thinking of you

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  • Posted

    Dear Cheryl,

    I am recovering from a triameollar fracture and like you dislocated it.. I broke it on the 16th of july ,dancing at a wedding .I fell badly.It has been a long road.After my operation 11 pins and 2 plates ,I was in a back slab for a 2 weeks and then a cast for 6 weeks and an air boot for a month. I was told to remove air boot at night and not to sleep in it.Night time was a nightmare as sheets were painfulI .I have had to have a lot  of physio and still am. I had to wait till my air boot was removed to start physio.I am stillin pain around my ankle knuckles and my achillies muscle is sore as hell.

    My surgeon wants me to have my metal work removed next spring as he thinks I am sensitive to it. thinking of you ,ankles take a very long time to recover from. 

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  • Posted

    Sounds as though you've been treated appallingly. So sorry to hear that this has been your experience. Definitely request a second opinion.

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  • Posted

    ***UPDATE***

    Good news and bad news! So I did exactly what the Orthopaedic surgeon told me to do and that was to call the Anesthesiology Department at the hospital. Of course I couldn't find their number from my post op instructions, however after many calls and departmental transfers, I finally got an on-call anesthesiologist to call me back. I remembered him as being one of the Anesthesiologists who called me to check on me after surgery to see how my nerve block was working and who told me how to take the wire out of my leg 5 days after surgery. I remember telling him I was still really numb but the pain medicine ball was completely empty so he said the numbness might last a few more days but then should wear off. So I told him it was now 6 weeks later and not only was the numbness worse but also extremely painful. He asked why I hadn't called them earlier to let them know and I told him I let my orthopedic surgeon know at my 2 week post op visit and again at my 6 week post op visit. I told him about my horrible 6 week post op appointment and how I was told to call their department and he said he was surprised that it wasn't the surgeon calling them. However he was glad I called and he asked me a lot of questions and said he would consult with the department head as well as my surgeon and call me back. I got a call back the very next morning from the exact anesthesiologist who performed the nerve block I got the morning before the surgery. She remembered me and said I needed to come straight in to be examined. I told her no one had examined me or even touched my foot since my surgery. I went straight in with my sister right to the pre op area I had been to where they were expecting me and she met me and must have spent a good 2 hours with me!! She asked me tons of questions, remembered giving me a double nerve block since I would be having surgery on both the inside and outside of my ankle, did an ultrasound, and a thorough exam using crushed ice in a glove and a sharp pin. Her conclusion? That with my numbness below the knee on both the inside and outside of my leg and foot, it must be damage to more than one nerve. She then called over the on-call Neurologist who came and gave me an even more thorough exam. His diagnosis? Severe CRPS. Prognosis? 10 months, and most likely longer, of disabling nerve pain. He said that the 400mg 3x a day of Gabapentin was still relatively low and that he wanted to raise it to 1200mg 3x a day but to increase slowly by 100mg every 3 days. He said he would get me in for nerve conduction studies and refer me to Physical Therapy ASAP. So the good news is I got some really good care by these 2 specialists and finally got properly examined, and the bad news is I definitely have CRPS. And that makes sense with all the numbness and burning pain I've been having that's above and beyond what I should be experiencing. But I feel somewhat relieved knowing that I've been referred to get some therapy and nerve tests and will be looked after much better than my Ortho docs had done. Later that evening my Ortho surgeon called me saying she had received the report from the the anesthesiologist and Neurologist and asked how I was. I told her how lovely they had been and how thorough they were and all she said was this... am I taking Vitamin C and that I should get a bucket and buy a large bag of rice to put my foot in to gain some strength back. Of course, when I go see the Neurologist and Physical Therapists if they recommend this rice in a bucket advice. After reflecting on things this weekend and dealing with this horrible pain, I am going to call this week and see if I can get something stronger than Tylenol for the pain because I am really miserable, especially in the later afternoon and nights, and very uncomfortable with this pain. I'm really hoping they'll give me something to take the edge off. The Gabapentin isn't doing much to be honest.

    Thank you guys for the lovely replies to my post!! If you have any questions or need advice on anything, I hope I am able to help in any way I can!!

    Cheers,

    Cheryl

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