Piton ankle fracture

[Bett]

I am a 67 yr old female,who on dec 23, missed one step, dislocated and pilon fracture, complete with 3 pressure wounds.had surgery on dec 30, 14 pins, 2 plates and told it was a very very very bad break.lots of pain.skip to 3 months later, still horrible pain, swelling, purple foot and one quarter size pressure sore remaining.doing well in pt, working like a horse and swallowing oxy. Well, I tripped with the walker now breaking my right wrist.surgery next day-6 pins and a plate.and no osteoporosis.
i am seeing a pain management dr as both surgeons basically say that fixing breaks is their thing, not managing pain.
im doing everything I'm told. Medicare in the process of cutting me off, pt will attemp an appeal, and then I will be out of pocket.
my rom is pretty good, don't remember the per cent but it seems my progress has slowed down. My concern is the pain.everything I read seems to indicate that I shouldn't have the amount I am experiencing.i realize the broken wrist didn't help me but I continue to have a purple foot when not elevated, still the remnants of the pressure sore, stiffness. The pt now wants me walking with a cane to improve my gait.i also must admit to haver some previous lower back issues (l4-5) that caused me to be unable to tie my right sneaker and have the slightest limp.
so I guess I'm looking to hear if I should be concerned regarding the pain, that requires oxy, tho always at least one pill less than permitted.
i know it was a bad break, I know my age is against me.neither the pt nor surgeon is terribly concerned basically telling me it will get better.
ok, lots for a first post.
thanks in advance for any words of encouragement. I can use it!

[Bett]

I meant PILON ANKLE FRACTURE

[old goat]

Not an orthopedist but a few thoughts. Oxy=oxycodone or oxycontin.? Either way, if you are taking around the clock so that there is a constant blood level narcotics lose effectiveness after a couple of weeks. Oxycontin of course is designed to be used around the clock, so if that's what you're taking probably not the best way to manage a problem like yours. If you can space out the oxycodone doses by using nsaids (ibuprofen, naproxyn) in between you might find the oxy is more effective when you take it. Your pain doc can also suggest other drugs--usually used as antidepressants or anti-seizure meds--that can be effective for chronic pain. They can be taken around the clock without your developing tolerance.
The swollen purple foot is due to the failure of the calf muscle pump. When you walk, flexing your ankle with your calf muscle pumps the blood out of the foot back to the heart. With your ankle surgery I'm sure you're not flexing the ankle much, if at all, when you walk, so the blood pools in your foot. If you aren't using one already a graduated compression stocking may help.
Re the PT. Look at this if you haven't already--http://www.medicare.gov/coverage/pt-and-ot-and-speech-language-pathology.html
I'm no expert on coverage--just got my medicare card myself--but it looks like if your therapist documents the continuing necessity and the fact that you are making progress you might be able to get continued coverage. Sounds like it depends on who reviews your case for medicare. So the key would seem to be getting your PT to document the heck out of it.
Good luck.

[Bett]

going to pain med dr on wed and will discuss alternatives. probably not able to take anti inflammatories due to previous ulcer issue. i am a mess, huh?
are you thinking of neurontin? what is the anti depressant you mention.

my pt guy is trying to fight the medicare decision, keep giving me the services and hope they pay. i know they need to show improvement which we have done but i still need the services .one way or another i will get them but it will piss me off if i end up paying.

thanks for any help and advise you can give.

[old goat]

going to pain med dr on wed and will discuss alternatives. probably not able to take anti inflammatories due to previous ulcer issue. i am a mess, huh?
are you thinking of neurontin? what is the anti depressant you mention.

my pt guy is trying to fight the medicare decision, keep giving me the services and hope they pay. i know they need to show improvement which we have done but i still need the services .one way or another i will get them but it will piss me off if i end up paying.

thanks for any help and advise you can give.

Neurontin is one of them. (anti seizure). There are a number of others--both anti-seizure and anti-depressants (but not currently popular anti-depressants like Prozac). I've used various ones on perhaps a few dozen patients. They work better for some people than for others. They aren't magic--not as effective as narcotics are in the short term. Narcotics are still the most effective pain meds there are and would be the safest if it weren't for that pesky little tolerance/habituation problem. (BTW I think the narcotics pendulum, which has swung back and forth a few times during my career, is currently too far to the anti-narcotic side, after being too far to the pro-narcotic side a few years ago. I may be biased--I practiced in a closed system where every doc seeing a patient had access to their med list--we were able to head off addiction problems, although if someone is determined to be an addict nothing will stop them.)
Too bad about the ulcers--if your ulcer was H. pylori related (if it was you would know what I'm talking about) and if you are H. pylori free, NSAIDS might be safe, especially if you took an antiulcer drug with them, but I wouldn't do it myself or prescribe it.

[Bett]

old goat-i sent you a PM

[Bett]

ok, so yesterday i had an appt with ankle dr and pain dr, took my friend cristina with me, (shrink, but a dr). complained how the plate hurts and i can feel it when i wear shoes, constantly hurting. well, all of a sudden dr says he can remove plate and all 14-19 screws. whaaaat? in the beginning he said hardware stays in, perhaps due to my age for this kind of break, maybe my healing, i don't know but i was in shock. he tells me it's out patient, takes about an hour and i walk out. no gym for a week. I've been going to gym where i have pt, 6 days a week, for 3 hrs (half hour spent on broken wrist). do the treadmill, a mile in 22-23 min. not looking to run a race, and holding on, but do it 6 days. PT guy says i am an "inspiration" to other patients, but when it's going to rain, i feel very far from an inspiration. still on oxy, (less) and neurontin (more) but often in lots of pain . shoes are very difficult, as it usually is cut to high and rubs the god damn plate. ok, I'm still in shock. tells me i walk out of outpatient surgery, probably without a boot, (whatever makes you happy) and no gym for a week. so, I'm nervous, have another appt and didnt schedule surgery . yet. thoughts? or is this a no brainer.

[Bett]

went to ankle dr yesterday. complained about the plate and he now tells me he can , as outpatient remove all hardware . originally he said hardware stays in but now……we're talking about two plates and 14-19 screws. is this a no brainer and i should just "go for it"?
help me out here guys.

[XXX-er]

I 've had a piton fracture (kayaking off a bridge) and the screws were left in which didn't hurt after healing but it did interfere with the surgeon fixing my next broken leg which was a spiral fracture ( non releasing telemark binding) . So I had all the hardware taken out 10 months after the 2nd accident including 2 of 3 screws from the 1st accident ( one screw was stuck in there ) IME getting all the HW out is not near as painful as when they put in I assume because there is nothing broken/ no trauma, they cut me open take it out stapled me up, I walked out of post op and I skied that year

so IME ... go for it

[Bett]

sounds good to me. the PT said , usually, if the plates or screws hurt and they can come out, ……it's really the plate that is so close to the skin and hurts like a …….but i also have close to 19 screws so that's making me nervous but again, i didnt go to med school and the dr did so i am assuming he knows what he's talking about. i think he's trying to alleviate pain for me, as I'm still moaning and groaning. thanks , looking for more responses too.