Zack’s follow up with his orthoped (is that a word?) this morning was initially scheduled for 11 am then moved up to 8:30 for an impending snowstorm. This impending storm even canceled school last night. It is so unusual and so exciting for a school day to be called the night before! Usually, I am in bed by 8:30 but I was busy texting with 2 school friends trying to speculate the likelihood of a 2 hour delay, as that would free me up to get Zack to the dr without asking for any additional help from my colleagues. And then poof! A snow day!

Luckily, the storm came very late and our drive up to and back down from Incline was completely without incident or snow.

So we met with Dr. Rupp’s medical assistant first then his PA. I have a bias toward nurse practitioners because of our friend, Emma, but our friend, Ben, has been swaying me toward PAs 🙂 and this morning we had a great experience with Kyle.

He took Zack’s stitches out and explained why Zack has a rash on his thigh. Apparently, it’s a common reaction to the solution that the anesthesiologist uses to clean the skin before the nerve blocker injection. Which is fine and we can treat the rash now but I do wonder if this rash is a common reaction, maybe they could find another cleaner or let people know that this might happen. (I have lots of suggestions for anyone who asks!)

Because Zack’s surgery included meniscus repair, Zack will continue to stay off that leg for 2 and 1/2 more weeks or so. If things look good when he goes back for another appointment in early February, he might be allowed to start walking with just the brace.

His brace was fitted and put on when his knee was the most swollen right after surgery so Kyle adjusted it all to fit now, when his knee is nearly back to normal size. Zack can unlock it when he’s on the couch or in bed but will lock it at 15° when he’s up and about.

Other odds and ends: Zack weened himself off the narcotic pain killers so that’s great. Kyle said he can drive as long as he can operate the brake pedal safely and get in and out without putting weight on his right leg. We’ll have fun practicing this weekend as he’s anxious to get back to work on Monday! And he can restart PT as soon as possible with a focus on straightening out his leg, developing his quad muscles to get ready for walking down the road. I talked to Mimi, the PT he saw on New Year’s Eve and she is very frustrated with us. Over 3 phone calls, she’s spent 6 hours on hold with the parent company of Zack’s insurance, which is pretty generous of her. She’s going to let us know tomorrow if she’s heard back from them and where we’ll go from there. If they don’t approve the therapy for him with her, I will try calling and harassing (a growing skill set of mine) and/or we can try a larger PT firm.

If you’d like a more technical summary of today’s visit:

Kyle L Erkkila, P.A.-C. at 1/16/2020 8:30 AM
S:
Chief Complaint
Patient presents with
•
Knee Problem

Right Knee post-op 1/7/20

47 y.o. male for follow up from right knee surgery on 1/7/2020. Patient doing well. Patient has been decreasing his pain medication. Patient has not started formal physical therapy.

O: BP 136/80 | Pulse 82 | Resp 16 | Ht 2.007 m (6′ 7″) | Wt 93 kg (205 lb 0.4 oz) | BMI 23.10 kg/m²
GA: NAD
Right lower extremity: Patient has no ecchymosis. Papular rash red throughout inguinal right thigh extending down to distal medial quad. sutures in place sutures removed. Steri-Strips applied. Lachman’s testing is solid. Range of motion 0–15– 60

A/P: s/p ACL repair with medial and lateral meniscus repairs.
Nonweightbearing for total of 4 weeks
Gradually increase weightbearing to full weightbearing at 6 weeks
Patient will he wear a brace when ambulating.
Patient will discontinue pain medications
Patient will start formal physical therapy to work on range of motion. I discussed the importance of getting full extension of the knee. Patient’s questions were answered. Patient is going to use cream cortisone as well as antihistamine cream due to rash on right leg.

Kyle Erkkila PA-C for Dr. Rupp.