[lindkaye]

Ok - not sure if I should jump for joy (as if I could) or run (again - as if I could!) hehe. Ortho dr called and I am set up for open debridement on my knee for arthrofibrosis due to my knee replacement Nov 19th. This is where I also have my RSD. The hopes are that getting some of the scar tissue gone, I can get my knee bending some (-15 extension and 80 flex). Right now the knee has been so flared I have only been doing home therepy so hope you can understand I am hesitate on this surgery. I want to be able to walk better - but do not want more pain! They are talking about keeping me 4 days for pain management - but no prior pain management before surgery. At first the nurse stated just I would be there just for overnite - then I had to bring up the RSD factor and that she might want to recheck with the ortho dr. so they came back with the 4 day stay. I have read that it does help sometimes to do a block a day prior to surgery. Any advice on this or experience? I am assuming they will be doing a block of some sort afterwards but wont know the details until a week prior to surgery when I have my pre surgery meeting with the surgeon and then with the anethesia dept. I have read good things about Ketamine being used in the block - any advice on this or experience? Would it be to my advantage or would I be out of line in asking the anethesia dept this and requesting this treatment? I have been trying to be more proactive in my treatment - sometimes met with hesitation from the docs so never sure. My pain man. doc has stated he will see me after the surgery as I probably will need more meds than what I am currently on..... sounds exciting huh? Should I call and see if he will be seeing me in the hospital - I know the ortho doc had conversations with him in regards to if they should do the surgery - but nothing was said if he would follow up in the hospital with me. It would make me feel better I think if I knew he would be following up on me during this time - but not sure where the cut off is from his duty to ortho to anethesia dept - so confusing! Sorry about the rambling and this so long - I really appreciate this board and the support from people that have RSD also and know what I am going thru with this very frustrating condition. One good thing - I won't have to cook the turkey this year! Maybe thats not a good thing ...considering my hubby's cooking! hehe

[Iffynah]

From everything I have read on RSD that is a bad idea to do surgery.

[kejbrew]

lindkaye,

Surgery always has a risk of complications, but if there is a possibility that you will gain more functionality by having the procedure all you can do is make sure that you get all of the information so that you can make an informed decision.

There is never any harm in questioning the surgeons and everyone else involved in your treatment. They are not the ones who will have to live with the results, you are. Make sure that everything possible is done to mitigate pain before, during, and after your procedure.

Hopefully there will be at least two good things to come out of your situation, 1) you will have less pain, and 2) a mouth-watering turkey dinner lovingly prepared by your husband the Thankgiving chef! I should have said three things actually, 3) better range of motion in that knee...

Best regards,

EJ

[lindkaye]

Yes - its been a hard decision for the surgery. I have been in PT for 10 months now, with 1 manipulation, and not really made any progress at all. I have also done 5 lumbar blocks which did help some on the range of motion right after the block - but within 4-6 hours, it was back to normal. In consulting 2 ortho drs and my pain management doc, it seems to be everyone's argreement that this might be the only last procedure to try to regain motion. I realize it can cause the RSD to flare or spread, but feel I have to make every effort I can to get rid of this walker & cane! Guess I need more practice in the area of "standing my ground" with the docs and being more of my own advocate instead of just listening and doing without questions. Now if I could only get my husband's cooking to improve before I go into the hospital....... hehe.

[Mslday]

I'm sorry to hear you have to have surgery on your rsd leg and I understand your apprehension and concerns expressed here. I just went through a surgery in August, mine was on my rsd foot. I flew to Germany to have some metal screws removed from my foot and my husband handled all of the arrangements and translated everything for me, it was difficult to not have complete control over what decisions were being made. I just kept telling myself that everyone was doing their very best to help me, and that was very true. I did not have a block before the surgery because of the circumstances with travelling. We had in-depth discussions about whether or not I should have a regional or general anesthesia during the procedure. Ultimately I decided to go with the regional anaesthesia because it is believed to have better effects overall. The day after surgery I was given a 7 day continuous "peridural" anesthesia with Bupivacaine and an opiate. They don't seem to know what a peridural is here in North America. It is similar to an epidural but the catheter is a little bent and it gave them direct access to the sympathetic nerves of my left leg. There is the risk of losing control of bladder and bowel functions so they carefully increased the dosage until I was pain free. I was not allowed to get out of bed on my own even though I could walk.

It was hell when the catheter was removed, but I am now much better. I have been having weekly IV lidocaine infusions since I returned home.

I highly recommend that you read up about what you can do to help your body heal naturally and start implementing some of those measures before the surgery. I made a lot of changes to my diet and have been using supplements too. My goal has been to control the inflammation. I believed that that would will help to lessen the pain. I have been taking high doses of vitamin B & C as well as Omega 3 fish oil along with other vitamins. I am following an anti- inflammatory diet avoiding red meat, coffee, sugars, fatty foods... eating lots more fresh fruits, vegetables, ginger, green tea. I don't eat fish so I'm trying to get more Omega 3's with walnuts and ground flax seeds

Three weeks ago I started taking an enzyme called Serrapetase and I believe this has has helped me to turn the corner. In fact I was feeling so well this week that I cancelled my lumbar sympathetic block that I had been waiting a month for. I have much better range of motion in my foot now and way less pain. What pain I do have comes and goes and is relatively mild in comparison to my pre-surgery state. I was even out in the garden raking leaves last week. There is not enough research evidence to support any claims of pain relief by using this enzyme, but I thought since it didn't have any known side effects it couldn't hurt to try. My doctor had no issues with me taking this either, I just wish I started to take it sooner. Here is a link to the info on wikipedia. http://en.wikipedia.org/wiki/Serrapeptase

Clearly my IV lidocaines have had a significant effect on my rsd, helping to calm my sympathetic nerves down. That being said I think there are many great benefits in doing all we can do to help support the healing process. I can't take many medications used for nuropathic pain because of severe reactions. Overall I feel much healthier now.

Good luck with all your pre-surgery meetings and especially with the surgery and recovery time.

[ali12]

From what I have read on the internet and from my experience, you shouldn't have surgery on an RSD limb unless it is absolutely neccasary. I'm sorry that you have to have surgery and I hope that everything goes smoothly and that you don't end up in too much pain afterwards

I went into hospital last Wednesday for a procedure on my RSD leg whilst under general anaesthetic and to try and get rid of some of the pain afterwards, my PM Doctor gave me a Ketamine Epidural whilst I was asleep. The block took my pain from an 8 and a half to a 5. It wasn't an easy decision to make as to whether to have the Ketamine Epidural but I have tried every other drug and nothing has helped so it was a last resort. I'm glad that I did have the block because I don't think I would of been able to cope without it. The affects of the block lasted about 21 hours and then the pain started to return. I didn't have any severe side effects that some mention but I did have some pretty bad itching lol. I am now on Oral Ketamine and it helps but not as much as the epidural did and I have side effects where I feel as though I am drunk and laugh at every single thing, that probably isn't even funny lol.

I would speak to your Ortho or PM to see what they feel is the best way to manage your pain. I'm glad that they are keeping you in for the 4 days to try and help control your pain.

I wish you the very best of luck with your surgery and please keep us updated when you can.