Scar tissue after knee replacement

Posted by leithlane @leithlane, Jan 31, 2017

I had knee replacement surgery 6 weeks ago . Through PT I have been working on breaking up the scar tissue only for it to regrow by the time I get back to PT two days later. I have been massaging at home, using a hand held massager and roller. It is painful and swollen. I am getting very disheartened. Any suggestions as to what else I can do. Has anyone had laser treatments to break up scar tissue? Were they effective?

@contentandwell

@melcpa86 Is the PT as bad after a lysis procedure as it was after the original TKR? I think I really need to think about this.
JK

Jump to this post

With me, I found hydrotherapy very beneficial following the arthroscopic lysis surgery, and was in the pool 36 hours post op. The physio was not nearly as bad as it was following the TKR, I spent hours either trying to dangle my legs off the dining room table, or trying to pedal on an excercise bike. I experienced neuropathic pain, had my dosages of baclofen and amitriptyline increased and was able to bend my knee.
My knee bend still is not ideal at 96 degrees even at 4 months following the lysis surgery and nearly 10 months following my TKR. I have been told by my physio that my knee bend might never improve which is a great disappointment as I am relatively young (53).

REPLY
@dduke

In my experience (I also had the lysis), the P.T. was not as painful as it was originally, you are working through the scar tissue and not the surgery, but, it has to be almost constant. I configured a bike of ours into a stationary bike. After the lysis, I set the timer for three hours and woke myself up every three hours and biked for 10 minutes. Had office P.T. every day and did PT at home several times a day. The knee is not perfect but can do about everything I want. Pushing hard I can get 130 degrees.

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@dduke was every three hours what was recommended? I cannot imagine getting up to bicycle.
JK

REPLY
@gator1965

With me, I found hydrotherapy very beneficial following the arthroscopic lysis surgery, and was in the pool 36 hours post op. The physio was not nearly as bad as it was following the TKR, I spent hours either trying to dangle my legs off the dining room table, or trying to pedal on an excercise bike. I experienced neuropathic pain, had my dosages of baclofen and amitriptyline increased and was able to bend my knee.
My knee bend still is not ideal at 96 degrees even at 4 months following the lysis surgery and nearly 10 months following my TKR. I have been told by my physio that my knee bend might never improve which is a great disappointment as I am relatively young (53).

Jump to this post

@gator1965 hydrotherapy? As in using a whirlpool bath? I’m surprised that you were able to use this so soon after the procedure since I assume the cuts were not healed yet.
What your flex prior to the procedure?
JK

REPLY
@contentandwell

@dduke was every three hours what was recommended? I cannot imagine getting up to bicycle.
JK

Jump to this post

This was not recommended. I just didn't want that scar tissue to take over again and thought that frequent bending would help.

REPLY
@dduke

This was not recommended. I just didn't want that scar tissue to take over again and thought that frequent bending would help.

Jump to this post

@dduke I admire your tremendous committment, getting up in the middle of the night to exercise. If I do go ahead and have this done I will, like you, set a clock to exercise every three hours- except during the night.
JK

REPLY
@contentandwell

@blessangela2019 Once scar tissue forms I don't believe it will go away without some surgical intervention. I cannot say that I am 100% sure, I could be wrong. I was not familiar with astym so I just googled it. It sounds very encouraging. To increase my flex in the knee done in October 2017 this is what the surgeon's NP said:

An arthroscopic lysis of adhesions is what the procedure is called. The doctor goes in with a small camera and a small tool that burns the scar tissue away. He doesn't use the long incision. He makes two small 1/2 inch incisions to get his tools in the knee. It's same day surgery. You go home after the procedure. You walk, fully weight bearing right away. You start using the bike the day after surgery. Treadmill would wait several weeks until you have minimal swelling and get good motion on the bike. Once we see you at your first post-op appointment approx 10-14 days after surgery we see how your incision is healing and will let you know when you can get back in the pool.

Is your doctor proposing the astym procedure? If you have confidence in him I would go with what he advises. If you are not sure you should get a second opinion.
I have no idea which procedure is the best, but if your doctor tells you more about the astym, I would be interested in it, if you could share it.
JK

Jump to this post

Thank you for your info. My Dr hasn't recommended anything. He's a once and done kind of guy. I'm inquiring about things I have googled or read about else where. I haven't been to PT since Sept 2018 but I have been doing all the excercies I've been given only for the scar tissue to rebuild quickly. I return to PT tomorrow and then I will throw all my research at them. I really want message therapy or lasser. No more cuts. I'm done with cuts. My left knee is starting to give out but I will NEVER go under the knife again. I will keep you posted on my progress. Think positive. I pray we all get relief soon.

REPLY
@contentandwell

@melcpa86 Is the PT as bad after a lysis procedure as it was after the original TKR? I think I really need to think about this.
JK

Jump to this post

@contentandwell – after the orginunal TKR – my PT was about 1.5 -2 hours a day and was half strength and half stretching. That is a far cry from the one hour stretching 5 times a day that my PT after the lysis was for the first 2 weeks. With the lysis I then went to 6 hours (3 sessions a day) of mostly stretching with about 30 mins walking and 10 mins on an elliptical or bike. Yesterday – he moved me to 2 sessions (and reduced the work) – so I think I’m now down to 2 or 2.5 hours a day – which is more in line with my TKR. (I’m 8 weeks out from the lysis more). I go to see him 3x a week and his sessions are 2 hours. After the TKR my session with him were 2x a week for an hour.

The surgeon also told me I would be out of work for 2-3 weeks after the surgery. I was out 6 for this due to the PT level and how exhausted I felt. Even now – I’m only back at work 6 hours a day. That will last until I’m at 12 weeks.

I thought long and hard and did a ton of research before I had this done. My surgeon Is the football and soccer team surgeon for a major university in Texas. I use his recommended PT. I’m 54 and just couldn’t live the way I was. I promised both my surgeon and PT I would do exactly as they said and ONLY that. The forced stretching up until this week had me in tears until this week because it’s that different from the TKR. However – it’s working. I came out of the lysis surgery at 132 and can almost do that myself now. PT only gave me a little push yesterday.

REPLY
@melcpa86

@contentandwell – after the orginunal TKR – my PT was about 1.5 -2 hours a day and was half strength and half stretching. That is a far cry from the one hour stretching 5 times a day that my PT after the lysis was for the first 2 weeks. With the lysis I then went to 6 hours (3 sessions a day) of mostly stretching with about 30 mins walking and 10 mins on an elliptical or bike. Yesterday – he moved me to 2 sessions (and reduced the work) – so I think I’m now down to 2 or 2.5 hours a day – which is more in line with my TKR. (I’m 8 weeks out from the lysis more). I go to see him 3x a week and his sessions are 2 hours. After the TKR my session with him were 2x a week for an hour.

The surgeon also told me I would be out of work for 2-3 weeks after the surgery. I was out 6 for this due to the PT level and how exhausted I felt. Even now – I’m only back at work 6 hours a day. That will last until I’m at 12 weeks.

I thought long and hard and did a ton of research before I had this done. My surgeon Is the football and soccer team surgeon for a major university in Texas. I use his recommended PT. I’m 54 and just couldn’t live the way I was. I promised both my surgeon and PT I would do exactly as they said and ONLY that. The forced stretching up until this week had me in tears until this week because it’s that different from the TKR. However – it’s working. I came out of the lysis surgery at 132 and can almost do that myself now. PT only gave me a little push yesterday.

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@melcpa86 thank you for the info. I appreciate knowing more from a patient's perspective before I make my decision. That's a lot of PT, for sure, and I'm not sure I will do as much as you have, so I wonder if it could actually set me back. All good questions to ask my surgeon.
JK

REPLY
@contentandwell

@gator1965 hydrotherapy? As in using a whirlpool bath? I’m surprised that you were able to use this so soon after the procedure since I assume the cuts were not healed yet.
What your flex prior to the procedure?
JK

Jump to this post

My flexion pre lysis procedure under GA was 70 degrees, prior to the MUA (3 months earlier ) it was 60 degrees. It is now about 96 degrees and the physio says that this is the best it can be. I get a lot of swelling after a day at work, and a great deal of neuropathic pain, I guess I am going to have to live with this.the lysis surgery allowed me to return to work after just short a year off sick. My journey started with a diagnostic arthroscopy 14 months ago. My arthritis was very aggressive and went from no evidence to stage 4 and eventually bone on bone in 9 months.
Hydrotherapy the water is highly chlorinated, and much warmer than a swimming pool it is like having a warm bath. Simply you excercise in the water. I had to wear a waterproof dressing over the sutures

REPLY
@blessangela2019

Thank you for your info. My Dr hasn't recommended anything. He's a once and done kind of guy. I'm inquiring about things I have googled or read about else where. I haven't been to PT since Sept 2018 but I have been doing all the excercies I've been given only for the scar tissue to rebuild quickly. I return to PT tomorrow and then I will throw all my research at them. I really want message therapy or lasser. No more cuts. I'm done with cuts. My left knee is starting to give out but I will NEVER go under the knife again. I will keep you posted on my progress. Think positive. I pray we all get relief soon.

Jump to this post

Good Morning, Angela (and all) –

If you can (individually – and all) step back a little bit from the individual tough circumstances of your own "tree",
you can begin to appreciate that there is a literal huge "forest" of unsupervised recovery out there – with most
of these folks – some with slightly different circumstances fighting essentially the same battle; that is – that our
recovery is often a losing race against inflammation and resultant scar tissue formation… with surprisingly so
many of us willing to "accept" what we are getting as a long term outcome (although this is NOTHING like what
was described to us – when they were trying to get us scheduled for surgery). What other business would expect
to be paid in full for these kinds of results (and an additional financial insult to previous injury – if there are MUAs,
arthroscopies, and revision surgeries required). Having a bad long term outcome actually represents a further
advantage to the medical surgical and device industries. You know what I'm also starting to wonder… I'm wondering
how much of this joint replacement surgery gone wrong (for the patients) is contributing to opioid pain medication
problems with dependency and worse outcomes on that. Now that pharma (J&J Jannsen, Purdue, etc.) have been
caught with their hands in the cookie jar both in misrepresenting the dangers and then with their own research in
hand showing these… went out and more aggressively marketed "the product". When does someone trippingover
that "elephant in the room" start the discussion of WHY so many people (who NEVER took pain meds before) are'in such serious chronic pain – that now (and for the forseeable future) they have to. This kind of pain is not something you can be "counseled out
of", "meditated out of"… or can it be ignored by a "more positive mindset". At some point, the medical surgeical device industry
must be held responsible for their outcomes (and only WHEN they start to be – will they EVER have much interest in being personally
or at all – involved in their patient's recoveries). As long as they don't absolutely "have to be"… they won't be. It isn't (or shouldn't be)
a question of "Well… they're not getting paid enough to also provide this". My last TKR cost slightly over $94K (believe it or not) and
the MUA (which took less than 15 minutes of my surgeon's time – basically wrenching my knee around while I was under anesteasia)
was about $ 8.7K (and neither of these charges included the anesthesiaologist – who had a separate charge for each) This is a little like the $500 toilet seats for the Dept. of Defense…. where you have the public subsidizing costs which are completely unjustified as
far as the result received… and like those "no bid contracts" there is exactly ZERO review of cost versus benefit. When you look at
JUST the TKR surgical market, you can easily understand how the whole medical situation in this country is completely out of control
and maybe a race to see if they bankrupt us before they kill us (or vice-versa). The reason "no one is looking at this"… is because of
so much money spread around politics (with both parties) by Pharma, Medical, Surgical, and Device industry lobby groups. Of course,
they don't want a thing changed (and why would they ?)

Angela (and all), I REALLY want to hear of good results in each of your own individual cases (and it is heartbreaking to me personally
to hear so many who continue to have problems – as do I), but this is not at all an "Individual" problem – it's a systemic problem which
puts us all at risk. most TKR patients probably do end up with slightly better or just plain "bettter" outcomes than what they started with.
But we all should know by now – that there are a whole lot of people… who do not. And what happens to them ? To us ?

Definitely (Angela and others) please keep me posted on things you have done or tried – that have worked… and things that have not.
For me… the latest TKR has less consistent inflammation (probably because of the hypoallergenic prosthetic – this time, and a much
more restricted nearly salt-free, gluten-free, and sort of anti-inflammatory generally diet… which includes fresh fruit, dark berries, pecans, tumeric, and other items known to have anti-inflammatory properties). Still (for me) inflammation and pain (daily) drives
me to elevate and "ice" the leg several times daily. This "steals from me" most of my motivation and determination to get things done
and honestly… tends to make me a much more disagreeable person to be around (especially considering also regular sleep disruption
due to pain – mostly).

I'm not especially religious (honestly), but I doubt there is one of us who has not at times "prayed" and just generally asked for help
from whatever might be out there, up there ? Any help would be welcome. But… back here on earth… there is a definite cause and
effect relationship going on with these surgeons and their patients and I think objectively there are a lot of things going on that are
just plain "wrong"… and I think we would be hard pressed to put this down to just "hard luck" or "fate". For what it's worth (and maybe not much), I'm starting by wiriting my own congressman and senator (and I encourage you to do the same). Realistically, they probably
have more to lose than to gain by getting (at all) involved… including that political figures who make the most noise about the evils of "government sponsered healthcare" would never stop accepting the very best (and involved) care paid entirely at taxpayer expense.

But… that's what I'm doing, because I have to do something – and who knows ?

My best (all),

John
sponsered healthcare

Liked by damewocane

REPLY
@contentandwell

@gutthookd John, I am so sorry for all you have been through with your knee. I really never realized how fortunate I was to be doing as well as I am. I appreciate that a lot more now.
It will be interesting if the X10 does help you, if you get it I hope you will let us know how it's working out.
JK

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Dear JK (and all) –

Re the X10… I'm having problems getting answers (of any kind) after my first short phone conversation with a person
who was mainly in the "sales" end of this (these are a kind of short term lease @ about $ 125 per day). He suggested
that I speak with or have my physical therapist speak with a "physical therapy person" they have on staff, but in over
a week of calling – no response. Everything I was able to read off their site suggests that best results are immediately
AFTER surgery or an MUA (which makes sense – because that's when they have the best chance of "moving" the knee
towards gains in both directions. It's unfortunate that their area of availability is so limited and that they are so difficult
to get answers out of. If you think about it – they don't really have to provide much, because they have so many desperate
people out there who are willing to try anything at any cost or inconvienence. That's a tragic statement in itself.

But… I will continue to research this further and if I end up making this pilgrimage, I'll keep everyone there updated on
the results (good or otherwise). My main question is "Can this help me now 7 weeks after the MUA and about 14 weeks
after the surgery ?" All I'm getting is a sort of unspecified "maybe" (which sounds like we are only certain of the same one
thing – they will get paid regardless).

best all 9and thanks),

John

REPLY

Oh Jeez–I feel for all you knee people on here. I am a 65 year old retired oncology nurse. I had a TKR in 2010 and a MUA about 3 weeks after that. In the past 17 years, not the greatest ROM but I learned to live with it. I found if I rode my bike religiously–and I wired my left foot onto the pedal–since it wanted to slip off due to stiffness–if I rode my bike daily, I could keep my ROM. But I found it utterly AMAZING that if I didn't ride my bike every day, that by the next day of riding, my knee was very stiff again. Wow–that is some kind of tissue/adhesion growth rate!! So basically, I rode my bike 10-15 miles a day out of utter fear. In 2017, I got an ugly debilitating infection in the TKR and ended up going to the hospital via 911 and having it immediately debrided. I was on antibiotics for 7 months and was told by my infectious disease doc that ultimately, I would need to have it re-done since the infection would always be in there–silently smoldering. I have taken a chance by stopping the antibiotics and not having the surgery. So far so good. But I am kinda waiting for the other shoe to drop. In the meantime–THE DEBRIDEMENT HAS INCREASED MY ROM HUGELY!!! While my knee is ugly and swollen and criss-crossed with suture lines, I feel unbelievably lucky to have been able to have the emergency debridement and the subsequent increase in ROM. I have been to 3 different ortho people and they all say–"Don't mess with it. Leave it alone." The 4th one said "You will really regret not having this new TKR done now–when you are still 65 and fairly mobile. It's gonna be a lot tougher on you with each year that passes–when the infection flares up and you get back in serious trouble." Well, that may be the case–but in the meantime, I am enjoying my mobility and will cross the bridge when I come to it. I have a question about the stem cell ads I see in the newspaper. Can someone kindly tell me about it, if it could work for me, and what its goals are? Thank you. Love, Mary Ann

REPLY
@registerednurse

Oh Jeez–I feel for all you knee people on here. I am a 65 year old retired oncology nurse. I had a TKR in 2010 and a MUA about 3 weeks after that. In the past 17 years, not the greatest ROM but I learned to live with it. I found if I rode my bike religiously–and I wired my left foot onto the pedal–since it wanted to slip off due to stiffness–if I rode my bike daily, I could keep my ROM. But I found it utterly AMAZING that if I didn't ride my bike every day, that by the next day of riding, my knee was very stiff again. Wow–that is some kind of tissue/adhesion growth rate!! So basically, I rode my bike 10-15 miles a day out of utter fear. In 2017, I got an ugly debilitating infection in the TKR and ended up going to the hospital via 911 and having it immediately debrided. I was on antibiotics for 7 months and was told by my infectious disease doc that ultimately, I would need to have it re-done since the infection would always be in there–silently smoldering. I have taken a chance by stopping the antibiotics and not having the surgery. So far so good. But I am kinda waiting for the other shoe to drop. In the meantime–THE DEBRIDEMENT HAS INCREASED MY ROM HUGELY!!! While my knee is ugly and swollen and criss-crossed with suture lines, I feel unbelievably lucky to have been able to have the emergency debridement and the subsequent increase in ROM. I have been to 3 different ortho people and they all say–"Don't mess with it. Leave it alone." The 4th one said "You will really regret not having this new TKR done now–when you are still 65 and fairly mobile. It's gonna be a lot tougher on you with each year that passes–when the infection flares up and you get back in serious trouble." Well, that may be the case–but in the meantime, I am enjoying my mobility and will cross the bridge when I come to it. I have a question about the stem cell ads I see in the newspaper. Can someone kindly tell me about it, if it could work for me, and what its goals are? Thank you. Love, Mary Ann

Jump to this post

Hi Mary Ann @registerednurse – Welcome to Connect! Great people here with great experience to share. I'm 68 years old and had my first TKR in April 2017. My next one is coming up next Tuesday 1/29/19… I feel for you on the difficulties you experienced with your TKR. I would have been totally frustrated with those results. I'm curious about what kind of physical therapy you had? Wish me luck on my next TKR on Tuesday. I'm hoping I get good recovery on this one.

REPLY
@gator1965

My flexion pre lysis procedure under GA was 70 degrees, prior to the MUA (3 months earlier ) it was 60 degrees. It is now about 96 degrees and the physio says that this is the best it can be. I get a lot of swelling after a day at work, and a great deal of neuropathic pain, I guess I am going to have to live with this.the lysis surgery allowed me to return to work after just short a year off sick. My journey started with a diagnostic arthroscopy 14 months ago. My arthritis was very aggressive and went from no evidence to stage 4 and eventually bone on bone in 9 months.
Hydrotherapy the water is highly chlorinated, and much warmer than a swimming pool it is like having a warm bath. Simply you excercise in the water. I had to wear a waterproof dressing over the sutures

Jump to this post

@gator1965 Thanks for the explanation of hydrotherapy. I presume it is not like a hot tub, no whirling water. There is a hot tub at my health club but I tend to avoid it, I fear it might have bacteria in it and being immunosuppressed I have little defense against that.
Jk

Liked by lioness

REPLY
@gutthookd

Good Morning, Angela (and all) –

If you can (individually – and all) step back a little bit from the individual tough circumstances of your own "tree",
you can begin to appreciate that there is a literal huge "forest" of unsupervised recovery out there – with most
of these folks – some with slightly different circumstances fighting essentially the same battle; that is – that our
recovery is often a losing race against inflammation and resultant scar tissue formation… with surprisingly so
many of us willing to "accept" what we are getting as a long term outcome (although this is NOTHING like what
was described to us – when they were trying to get us scheduled for surgery). What other business would expect
to be paid in full for these kinds of results (and an additional financial insult to previous injury – if there are MUAs,
arthroscopies, and revision surgeries required). Having a bad long term outcome actually represents a further
advantage to the medical surgical and device industries. You know what I'm also starting to wonder… I'm wondering
how much of this joint replacement surgery gone wrong (for the patients) is contributing to opioid pain medication
problems with dependency and worse outcomes on that. Now that pharma (J&J Jannsen, Purdue, etc.) have been
caught with their hands in the cookie jar both in misrepresenting the dangers and then with their own research in
hand showing these… went out and more aggressively marketed "the product". When does someone trippingover
that "elephant in the room" start the discussion of WHY so many people (who NEVER took pain meds before) are'in such serious chronic pain – that now (and for the forseeable future) they have to. This kind of pain is not something you can be "counseled out
of", "meditated out of"… or can it be ignored by a "more positive mindset". At some point, the medical surgeical device industry
must be held responsible for their outcomes (and only WHEN they start to be – will they EVER have much interest in being personally
or at all – involved in their patient's recoveries). As long as they don't absolutely "have to be"… they won't be. It isn't (or shouldn't be)
a question of "Well… they're not getting paid enough to also provide this". My last TKR cost slightly over $94K (believe it or not) and
the MUA (which took less than 15 minutes of my surgeon's time – basically wrenching my knee around while I was under anesteasia)
was about $ 8.7K (and neither of these charges included the anesthesiaologist – who had a separate charge for each) This is a little like the $500 toilet seats for the Dept. of Defense…. where you have the public subsidizing costs which are completely unjustified as
far as the result received… and like those "no bid contracts" there is exactly ZERO review of cost versus benefit. When you look at
JUST the TKR surgical market, you can easily understand how the whole medical situation in this country is completely out of control
and maybe a race to see if they bankrupt us before they kill us (or vice-versa). The reason "no one is looking at this"… is because of
so much money spread around politics (with both parties) by Pharma, Medical, Surgical, and Device industry lobby groups. Of course,
they don't want a thing changed (and why would they ?)

Angela (and all), I REALLY want to hear of good results in each of your own individual cases (and it is heartbreaking to me personally
to hear so many who continue to have problems – as do I), but this is not at all an "Individual" problem – it's a systemic problem which
puts us all at risk. most TKR patients probably do end up with slightly better or just plain "bettter" outcomes than what they started with.
But we all should know by now – that there are a whole lot of people… who do not. And what happens to them ? To us ?

Definitely (Angela and others) please keep me posted on things you have done or tried – that have worked… and things that have not.
For me… the latest TKR has less consistent inflammation (probably because of the hypoallergenic prosthetic – this time, and a much
more restricted nearly salt-free, gluten-free, and sort of anti-inflammatory generally diet… which includes fresh fruit, dark berries, pecans, tumeric, and other items known to have anti-inflammatory properties). Still (for me) inflammation and pain (daily) drives
me to elevate and "ice" the leg several times daily. This "steals from me" most of my motivation and determination to get things done
and honestly… tends to make me a much more disagreeable person to be around (especially considering also regular sleep disruption
due to pain – mostly).

I'm not especially religious (honestly), but I doubt there is one of us who has not at times "prayed" and just generally asked for help
from whatever might be out there, up there ? Any help would be welcome. But… back here on earth… there is a definite cause and
effect relationship going on with these surgeons and their patients and I think objectively there are a lot of things going on that are
just plain "wrong"… and I think we would be hard pressed to put this down to just "hard luck" or "fate". For what it's worth (and maybe not much), I'm starting by wiriting my own congressman and senator (and I encourage you to do the same). Realistically, they probably
have more to lose than to gain by getting (at all) involved… including that political figures who make the most noise about the evils of "government sponsered healthcare" would never stop accepting the very best (and involved) care paid entirely at taxpayer expense.

But… that's what I'm doing, because I have to do something – and who knows ?

My best (all),

John
sponsered healthcare

Jump to this post

@gutthookd I can certainly understand your frustration and being very upset over all you have gone through. I agree, the percentage of people who are not happy with their "new" knees is really higher than acceptable, about 30% is what I have been told by people who tried to convince to not have my TKR a year ago.

I think a good part of getting a great result is picking a great surgeon. I would like a slightly better flex, mine is at about 118, but that's not bad and I have no pain. I can literally walk for miles. I honestly do not know one person who has not been happy with their TKR. A friend who has had two is out there skiing almost daily! A cousin had his done in outpatient and is ecstatic at the results, plus at my age, I know many more. I do know one person who had a problem. She spent two years trying to find out what the problem was. She finally found a doctor who diagnosed and FIXED it. She is great now.
I am just trying to say, the percentage of people who have had good results does outweigh those who have not. I am sorry for all you have gone through. I know I would be absolutely furious if all of that happened to me. I sincerely hope that you can find a doctor who can help you and give you relief from your pain.
JK

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