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Wednesday, August 19, 2009

My knee since the Total Knee Replacement

I've been fighting for increases in my disability rating since my first rating of 20% in 1994 when I retired from the Army. It's been a long, slow battle. Over the course of the last 15 years I have gone from 20 % to 50% to 70% to 80% and back down to 70%. They reduced me back to 70% after my total knee replacement (TKR) because they "assumed" my knee would no longer be unstable. I was supposed to be scheduled for a C&P the 13th month after my TKR and that never happened. The reduction came automatically and no one ever did an exam on my knee.

The fact of the matter is my TKR failed miserably. The VA was unable to fit me into their surgery schedule so I was outsourced to the Florida Orthopedic Institute. After months of physical therapy with little progress, I knew something was wrong. The TKR was the 8th surgery I'd had on my left knee. I know my knee and I know my body. I know when something isn't right. I started complaining. I started complaining LOUDLY. I was still in an incredible amount of pain. My knee was still giving out all the time. My knee was still swollen all the time. My right knee was taking all my weight and it was starting to get worse.

My primary care physician sent me for xrays and a CT scan. The CT scan showed some abnormalities in the left knee. Finally they sent me back to the surgeon at Florida Orthopedic. He came in the exam room and asked me a couple of questions. He didn't look at the xrays. He didn't look at the CT Scan results. He didn't lay his hands on my knee. He barely listened to my complaints. He told me to "lose some weight" (I'd already lost 30 pounds since surgery), get some exercise (I'd already been through 6 months of physical therapy) and then he released me to go back to work. He told me there was nothing more that he could do for me.

I was still on major pain meds. I couldn't even drive myself to appointments because I didn't feel safe behind the wheel of a car. I was in so much pain I could hardly walk. I have to sit for an hour & elevate my legs for an hour to keep my knees, legs and ankles from swelling like sausages. And that crazy doctor wanted me to go back to work. I left his office very upset as you might imagine.

I went back to my primary care physician and kept complaining. She sent me to the pain clinic and eventually I ended up where I am now --- on all these drugs and on all this morphine. Earlier this year I saw a PA in the Ortho Clinic for my left shoulder. My shoulders are all screwed up because of the knee that was replaced. My knee gives out on me frequently. When it does, I fall. When I fall I somehow always manage to land on one shoulder or the other. And it seems I'm never near anything soft when I fall so I always land on the ground and I fall hard. The doctors want me to use a walker for obvious safety reasons but my shoulders are so painful and I've lost so much range of motion in them that I can't support myself on one. I have to use a cane. On Friday I see a surgeon to schedule surgery for my left shoulder and the right one isn't far behind. But I'm straying off topic.

When I saw the shoulder PA, he was asking me about my knee since it's the reason that I fall. He asked me who did the surgery and I told him. I also told him I don't want to go back to see him because he told me that there's nothing more that he can do for me. Those were the doctors exact words. "There is nothing more that I can do for you." The PA was very cynical about the doctors at Florida Orthopedic and basically told me that once they get their money for surgery they want nothing to do with the Veterans in terms of after care. I believe it. The PA said to me, "We have a very good knee specialist right here in the VA. I'll make sure you see him." I was thrilled. For the first time in two years I had hope! He called the unit secretary and had her set it up.

About two weeks later, I get a call from Rita Hall who is a caseworker at Haley VA. She was preparing my paperwork to outsource me back to Florida Orthopedic to see my original surgeon. I told her I didn't want to see him because he'd already told me there was nothing more he could do for me, so why waste the money on a consult. I told her I wanted to see the knee specialist in the VA Ortho Clinic. Well, it turns out that he saw the consult, reviewed my records, saw that Florida Orthopedic had done the original TKR and he refused to see me. He was the one who wanted me sent back to Florida Orthopedic. Apparently, he doesn't want to clean up someone else's mistake.

I finally have an appointment in the Ortho Clinic to see a knee doctor. He's a second rate knee doctor & I've seen him before. He's got a lousy reputation in the Ortho clinic, even among the doctors up there. But, he's done me right in the past. He was the one who gave me the connection in my medical records to get me service connection for my right knee. He will write just about anything that I ask him to & he will use the wording that I ask him to use. He may be a second rate doctor, but he's definitely a Veterans Advocate. I've been trying for years to service connect my right knee. I had the opportunity when I first retired and they denied me, but back then I had no help and I was very naive about the whole process. I wish I knew then what I know now but hindsight is always 20/20. It's just too bad that I'll be seeing him after my C&P this week.

I'm at my wits end with the VA. I've got doctors telling me they can't find anything wrong with my knee, yet it buckles all the time, it's still very swollen two years post-op, it's still extremely painful two years post-op and I have zero quality of life because of it. It's affected every part of my life and my body. My shoulders are now so painful from falling that when I go to bad at night, I pack soft pillows under them just to be able to sleep. I sleep on my back all night long. I don't roll over at all when I sleep. Ever. It's too painful to try to sleep on either side. I can't reach above me, behind me or to either side. Reaching in front is painful, too. You should see me sitting here typing. It won't be long before I develop carpal tunnel syndrome. As it is, I have tingling in my hands and arms when I wake up and now I'm supposed to sleep in hand braces -- both hands. Because I carry my weight on the right side of my body, my right knee is getting worse. It needs replacement, too, but until I do something about the instability of my left knee, I'm terrified of having surgery on my right knee. If I fall after surgery & damage the right knee, I could do permanent damage. Where does that leave me?

I need help dressing, showering, and help with all my daily living needs. I can't leave the house unless I have someone to drive me. The powers that be at the Haley VA Hospital say I don't meet the qualifications for a mobility scooter. I'm enrolled in the Independent Living Program under Vocational Rehabilitation and my Counselor is trying to "back door" me one, plus a lift for my car through ILP. Hopefully we'll be able to pull it off. All she needs is for my PCP to say that I need it. Fortunately, my PCP is in my corner and I'm sure I can get her to put it in my medical records that it's a medical necessity. My PCP is as frustrated with the system as I am.

I still have hope that the system will work for me. I have some good people in my corner at the VA Hospital. I have an awesome Voc Rehab Counselor who is fighting for me. Maybe I'm looking at the world through rose colored glasses but I have to have something to believe in.

Tomorrow I have two C&P exams. I'm hoping they go smoothly and I have good doctors. If they are male doctors, I'm going to have a problem. I have a fear of male doctors so I will be demanding a female chaperon before the exams commence. If you've read my blog, you'll know that I was sexually assaulted by an active duty gyn doctor during a routine examination when I was stationed in Germany. That doesn't exactly give you much faith in doctors.

On a more positive note, I got a call yesterday from my social security caseworker. I submitted my application for social security disability in January. By May, I had completed all the exams they wanted. I sent them copies of all my VA Medical Records for the last ten years. When the caseworker called yesterday, she said Atlanta had sent back my employment packet for some clarifications of my work history. We were able to get that all fixed via phone interview. She is going to fix the packet and transmit it back to Atlanta this week. I asked her, based on her experience, if she thought I had a chance of winning my case the first time through. She said she is fairly certain it's going to be approved. When I applied for SSD, I applied for it using the same issues that I applied to the VA for 100% IU. Social Security has copies of all my award letters so they know that I am 70% service connected. Since they are expediting military claims I suspect I will hear something by the end of the year at the very latest. Keep your fingers crossed.

Those are my thoughts for today.

Until the next time ....

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