Filling In The Missing Pieces


Y’all might have noticed that I’ve posted a couple of very task specific entries to the blog the last couple of days and might be asking why now, why the push of information about filing a VA claim and the bewildering plethora of related data. Good and fair questions. If you weren’t wondering then that is okay as well, because I’m going to try to explain it all right now. In previous posts I wanted to express to any and all veterans the importance of arming oneself with the proper information. This is very fresh in my own skull since I just re-re-opened my own claim so I can provide additional relative information to strengthen the facts in my own file in hopes that I can get an increase in my own personal rating from the VA.

My process actually started in March of 2014, not with the claim, but with my claim in mind. I fulfilled a large portion of the leg work to eventually get the ball rolling. How so? Up until then I wasn’t in the medical portion of the VA, only in the claims side. But, when I was laid off I soon found myself in dire straights. Forget everything else, I was finding out fast that I was headed for a dilemma which if not contained may have had some major health complications involved. Why? I’m an insulin dependent diabetic. If you aren’t aware of the nature of that beast just look it up. So, my number one priority was to contain that fire before it spread. Since I was already in the system and a VA card holder, enrolling for medical benefits was simple enough, time consuming, yet fairly easy, even for a simpleton such as myself. Good grief I blew through some trees filling out that paperwork, it was insane, it was as if they couldn’t share the same sheet of paper in my file around the office, everyone needs a completely originally signed document in order to proceed. That is nothing compared to the mountain of papers (records and reports) I face at this exact moment. I have mentioned what a pain in the ass the VA makes the process, haven’t I?

As well, at the time of my lay off I was in line to do an exploratory and maintenance surgery on my knee to clear away debris, old hardware, and torn ligaments. Being told beforehand they couldn’t repair anything since it would only complicate things down the road. I had an my surgery date, I had time arranged to be off from work, and then I’m laid off. Talk about coming to a screeching halt, Yea, dead in my tracks, cancel all plans until further notice. Being laid off screwed up allot, allot more than I will mention here. Then, and only then did I considered enrollment into the VA medical program, something my wife says I should have done back in 2000, but I was stubborn, I had private insurance, I saw no need in being in VA medical. For the most part I was right, everyone hears the horror stories about veterans trying to get care, getting the wrong care, how slow the process is, and the same mistakes made over and over. Who wants to be a part of that kind of mess? But then, who do I turn to in my true time of need, who do I expect to be waiting there for me at the edge of the red carpet, you guessed it, the VA. I will be one, of millions who can attest to the slowness of the VA. Fuck their timelines because they look good on paper but have no relation in real time with real people, and that blows ass for every single one of us veterans.

Reluctantly, yet willingly, I got “in line” and jumped into the process. The process wasn’t hard, but it was time consuming, lucky for me, at the time, all I had was time on my hands. I had four months to ride this pony for the big show or it wasn’t going to happen. It took longer, duh, and when I was hired to a new company last October I hated the fact that I needed to take time off here and there to button up all the loose ends, and there were allot of loose ends. I was seen multiple times at the clinic’s version of an orthopedics office, where we discussed my direct interest in seeing the orthopedic surgeon downtown. But there is a process, first the PA has to be convinced of a “need” before we “bother” the busy orthopedic surgeons with what might all be in my head. In my fucking head you say? Let’s review, for the sake of argument, that this PA went through my private sector medical records, my military medical records, started my new VA medical records, the MRIs, the CT Scans, the x-rays, the exams, and so forth, and this motherfucker was convinced ALL of my pain was in my head. Look, I know real pain and I know manifested pain, there is a distinct difference. As well, I know that there is very little help in eliminating the pain of degenerative joint disease, also known as osteoarthritis, and that steroid enhanced visco supplementation injections are a sick fucking joke. There is NO over the counter medications or prescription medications which can stop the pain of bone on bone contact. Just ask me, I have tried many, many combinations, and get the same result, pain. Hyaluronan injections (rooster comb) are nice and beautiful by design, but I don’t just have arthritis is my knee.

Finally, somehow, someway, I convinced the PA to give me the recommendation I was wanting, after a final review I was scheduled to finally see an orthopedic surgeon, 13 months after originally asking. My first visit to the orthopedic surgeon gave me the impression the doctor was blown away with the damage in my knee and he was a little shocked I was still walking. The overall decay within the joint is estimated, by him and one other doctor, to be a 97% coverage. At first he discussed surgery to remove the weight bearing of the joint to shift it more out to the outside, but after further review, eight weeks later, I was told I’m not a candidate because I would need the unloader surgery on both sides, which cant be done. My only option was to have my knee replaced. However, that option is gone as well because it is claimed that because I’m under the age of 50 that the VA will not do that particular surgery. Even though the governing regulations state that age cannot be used as a determining factor but is still an option of the individual physician. Nice double talk, right? Right. In reality, I was told to tough it out, move on with my life, and just try to “take it easy” for the next 4 years. Needless to say, I’m beyond pissed. What a fucking joke! Now I can’t get treatment? Isn’t the VA here to take care of my service connected injury? Seems that the answer is they will do it at their leisure. Hell, I don’t mind waiting in line if that is the issue, I know times are tough, money is tight, and y’all are having your asses handed to you by the media and the investigations right now, but why just tell me flat out no.

I don’t take rejection well. I really don’t. I did my part. I played the game. I followed the rules. For what? For nothing, that’s what. I know, boohoo wo is me. Well, okay, getting up to go to work every day is a bitch. A bitch I don’t mind riding because there are bills to be paid. Plus, I’m not the kind to sit on my couch all day to watch Jerry Springer. I have a drive to get out and work, to be functional on a daily basis. I’m at a loss here. I decided, after a careful review of the entries into my visits to the doctor, where he cites in black and white, that I’m not a candidate for either surgery due to age and complications down the road in the future that “could” happen, and his recommendation is daily, regular doses of over the counter anti inflammatory medications and more quarterly injections. I will have my way, one way or another, so I re-re-opened my claim with the VA, providing all the supporting evidence from day one back in 1990 until now, to include findings from a civilian orthopedic surgeon which I see next week. We’re doing a review of my records to review treatment, and follow up with his recommendations. I really don’t give a shit about the money, I just want to get this knee fixed, hell or high water. It’s never been about the benefits, it never will be, it’s about not being taken of because of one jack asses opinion. In the end, my goal is to rattle enough cages to get my knee replaced, which is recommended by two VA surgeons and two civilian surgeons, so come on motherfuckers, replace it already.

Yes, y’all have found a sore subject with me. I’m tired of doing battle, the VA is supposed to be here to help me and fellow veterans, not give us the run around, not to deny us care, and certainly not to individually bend us over because it is the easier thing to do. They can kiss my hairy white ass first, I came to fight, I came to get what I need, I came to see that the VA does the right thing by me. Hopefully, my education along the way can be used by other veterans who are getting the big shaft. So, my plan is to continue writing and sharing information about how to make sure all your bases are covered. It doesn’t need to be a battle to receive care, the VA just makes it that way. I have friends within the VA system, many of them veterans, and they encounter the same bullshit the rest of us do. Who knows what will happen with my case/claim, anyway it turns out I hope that someone has read some of my postings and figured out how to get through to the VA. I know it is bureaucracy at work, policy and so forth, set in place to curb abuse and better promote the health and well-being of veterans, but it has backfired, and now we all suffer, thanks. Next time y’all think that we are being handed freebies, remember we are people too, we just want to live our lives as normally as possible.

Still Dancing With My Demons

I have found that information is the best way to educate my mind when I’m left with unanswered questions. Today is no different, actually Thursday was no different, as it was Thursday, yes that I had yet another bomb dropped in my lap by my friendly VA doctors. It was good news to hear that there is now a solution, but bad news because of what the solution involves when it comes to the repair and pain relief in my knee. Anyone who visits this blog regularly over the last several years will have read about my knee, my challenges with the VA, playing the waiting game, and in many ways, dancing with my demons, or at least entertaining them on a dark rainy night.

I really was blindsided as I was led to believe that I merely had ligament problems once again, but no, these two doctors took a very blunt and honest approach with me, thank you, and explained and showed me just how fucked my knee really is. First of all, bone to bone contact because of deterioration of the cartilage is a rather challenging pain to explain. As well, that same space being approximately 100% covered with arthritis. I’ve always said ignorance is bliss because it allows one to disconnect from something and become very indifferent to ones grief. So be it, not everyone has had a broken knee to include broken femur in two places, broken tibia, destroyed ligaments and muscles, and so forth. I get the precious innocence of ignorance to my personal hell. I give these doctors credit, it was like they were in my head reading my thoughts and knowing my daily challenges. It was cool but also some freaky voodoo shit was going down too, I think. It was almost nice hearing my own personal words coming out of someone else’s mouth right there in person. Anyway, below is the best description I could find about the corrective surgery. I have spent the last two days reading, trust me, but I think this might just be my answer. However, I will put this out there for y’all, if you know a better answer, please pass it on. So, here it is.

Originally written here.


Knee osteotomy is commonly used to realign your knee structure if you have arthritic damage on only one side of your knee. The goal is to shift your body weight off the damaged area to the other side of your knee, where the cartilage is still healthy. When surgeons remove a wedge of your shinbone from underneath the healthy side of your knee, the shinbone and thighbone can bend away from the damaged cartilage.

Imagine the hinges on a door. When the door is shut, the hinges are flush against the wall. As the door swings open, one side of the door remains pressed against the wall as space opens up on the other side. Removing just a small wedge of bone can “swing” your knee open, pressing the healthy tissue together as space opens up between the thighbone and shinbone on the damaged side so that the arthritic surfaces do not rub against each other.

Osteotomy is also used as an alternative treatment to total knee replacement in younger and active patients. Because prosthetic knees may wear out over time, an osteotomy procedure can enable younger, active osteoarthritis patients to continue using the healthy portion of their knee. The procedure can delay the need for a total knee replacement for up to ten years.


Depending on where osteoarthritis has damaged your cartilage, an osteotomy removes a wedge of bone from different areas of your shinbone. The most common type of osteotomy performed on arthritic knees is a high tibial osteotomy, which addresses cartilage damage on the inside (medial) portion of your knee.

The following surgery section provides details about the high tibial osteotomy procedure that apply in general to most other osteotomy procedures. The procedure usually takes one to one-and-a-half hours to perform.

During a high tibial osteotomy, surgeons remove a wedge of bone from the outside of your knee, which causes your leg to bend slightly inward. It is like realigning a bowlegged knee to a knock-kneed position. Your weight is transferred to the outside (lateral) portion of your knee where the cartilage is still healthy.

After anesthesia is administered, which may be regional, or general, the surgical team sterilizes the leg with antibacterial solution.Surgeons map out the exact size of the bone wedge they will remove, either using an X-ray, CT scan, or 3D computer modeling.A four- to five-inch incision is made down the front and outside of your knee, starting below the kneecap and extending below the top of your shinbone.Guide wires are drilled into the top of your shinbone (tibia plateau) from the outside (lateral side) of your knee. The wires usually outline a triangle form in your shinbone.A standard oscillating saw is run along the guide wires, removing most of the bone wedge from underneath the outside of your knee, below the healthy cartilage. The cartilage surface on the top of the outside (lateral side) of your shinbone is left intact.The top of your shinbone is then lowered on the outside and attached with surgical staples or screws, depending on the size of the wedge that was removed.The layers of tissue in your knee are stitched together, usually with absorbable sutures.

Day Of Surgery

At most medical centers, you will go to “patient admissions” to check in for your outpatient arthroscopic surgery.

After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your knee area may be shaved (this is not always necessary). You will wear a hospital gown and remove all of your jewelry.

You will meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room.

Here are some important steps to remember for the day of your surgery:You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general anesthesia.Wear a loose pair of shorts or sweatpants that will fit comfortably over your knee bandage when you leave the hospital.Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Recovery Room

Following a knee osteotomy, you usually stay in the recovery room for at least two hours while the anesthetic wears off.

This procedure typically causes significant pain. You will be given adequate pain medicine, either orally or through an IV (intravenous) line, as well as instructions for what to do over the next couple of days.

Your knee will be bandaged and may have ice on it. You may have significant pain early on and you should take the pain medicine as directed. Remember that it is easier to keep pain suppressed than it is to treat pain once it becomes present, so ask the nurse for medication when you feel pain coming on.

You should try to move your feet and ankles while you are in the recovery room to improve circulation.

Your temperature, blood pressure, and heart rate will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital or, if necessary, be admitted for an overnight stay. Most patients remain in the hospital for two to four days following an osteotomy.

Post-Op In Hospital

After knee osteotomy, you usually are taken to a hospital room where nurses, anesthesiologists, and physicians can regularly monitor your recovery. Most patients spend two to four days recovering in the hospital.

As soon as possible after surgery is completed, you will begin doing continuous passive motion exercises while in bed. Your leg will be flexed and extended to keep the knee joint from becoming stiff.

This may be done using a continuous passive motion (CPM) machine. The CPM is attached to your bed and then your leg is placed in it. When turned on, it takes your leg through a continuous range of motion.

There will likely be pain, and you can expect to be given pain medication as needed. Ice also helps control pain and swelling.

For two or three days after surgery, you may experience night sweats and a fever of up to 101. Your physician may suggest acetaminophen, coughing, and deep breathing to get over this. This is common and should not alarm you. The incision usually starts to close within six days and the bandage can be removed. Physicians commonly fit you with a knee brace that may allow a limited range of movement and helps push your knee into the correct position. For a high tibial osteotomy, the knee brace pushes your knee inward, making you slightly more knock-kneed. Please note that some surgeons will cast your knee for 4 to 6 weeks to ensure that the osteotemy heals.

You may be able to put some weight on your knee, but physicians usually prescribe crutches for at least six weeks. You will be given a prescription for pain medication and usually schedule a follow-up visit sometime around six weeks after surgery.


Most patients can begin physical therapy around six to eight weeks after surgery. Unlike other surgical treatments for arthritis, osteotomy relies on bone healing before more vigorous, weight bearing exercises in the gym can begin. In the best scenario, people respond to strengthening exercises and stop wearing the brace after the first three to six months of therapy.

Light exercise is one of the most effective ways to relieve arthritis pain by stimulating circulation and strengthening the muscles, ligaments, and tendons around your knee. Strong muscles take pressure off the bones so there is less grinding in the knee joint during activities. In conjunction with a healthy diet, exercise can also help you lose weight, which takes stress off your arthritic knee.


In the first few weeks of rehabilitation, your physical therapist usually helps you stretch the muscles in the hamstrings, quadriceps, and calves while flexing and extending your knee to restore a full, pain-free range of motion.

Aerobic Exercise

When pain has decreased, physicians generally recommend at least 30 minutes a day of low-impact exercise a day for patients with arthritis. You should try to cut back on activities that put a pounding on your knees, like running and strenuous weight lifting.

Cross-training exercise programs are commonly prescribed when you have arthritis. Depending on your preferences, your workouts may vary each day between cycling, cross-country skiing machines, elliptical training machines, swimming, and other low-impact cardiovascular exercises. Walking is usually better for arthritic knees than running, and many patients prefer swimming in a warm pool, which takes your body weight off your knees and makes movement easier.


Strength training usually focuses on moving light weights through a complete, controlled range of motion. You should generally avoid trying to lift as much as possible with your quadriceps and hamstrings. Your physical therapist typically teaches you to move slowly through the entire movement, like bending and straightening your knee, with enough resistance to work your muscles without stressing the bones in your knee.

Once your physical therapist has taught you a proper exercise program, it is important to find time each day to perform the prescribed exercises.

Recovery at Home

You will likely feel pain or discomfort for the first week at home after an osteotomy, and you will be given a combination of pain medications as needed. A prescription-strength painkiller is usually prescribed and should be taken as directed on the bottle.

Swelling in your leg usually decreases over a span of three to six months after surgery. There may be some minor bleeding for a few days, but by the time you are released from the hospital, most bleeding should have stopped. If you notice an increase in swelling or bleeding, you should call your physician.

Physicians generally recommend that you avoid putting stress on your knee until the bones have healed. Putting weight on your knee too early may damage the bone surface and prolong healing time.

Here is what you can expect and how you can cope after an osteotomy:Icing your knee for 20 or 30 minutes a few times a day during the first week after an osteotomy will help reduce pain. Ice therapy may need to intermittently continue for a few months if pain bothers you.As much as possible, you should keep your knee elevated above heart level to reduce swelling and pain. It often helps to sleep with pillows under your ankle.Immobilize your knee in the prescribed, hinged knee brace for about six weeks. You may remove the brace for brief periods to perform passive motion exercises with the aid of a physical therapist or a CPM machine. Range of motion exercises are important for healing. Regaining full extension is just as important as bending your knee.Your leg may appear slightly bent after the surgery as it heals into its new alignment.Most patients have to keep the incision dry for seven to ten days. Your physician can recommend a surgical supply store that sells plastic shower bags. Wait until you can stand comfortably for 10 or 15 minutes at a time before you take a shower.Crutches or a cane may be needed for between six and ten weeks, depending on the pain. It is difficult to describe the amount of pain any given patient will experience.Six weeks after surgery, your physician usually gives you a check-up. X-rays can determine how your bones are healing and whether you are ready to begin rehabilitation.You may have to take between six weeks and six months off from work, depending on how much you rely on your knee to perform your job.


After rehabilitation, preventing osteoarthritis is a process of slowing the progression and spread of the disease. Because patients remain at risk for continued pain in their knees after treatment, it is important they are proactive about managing their conditions.

A fall or torque to the leg during the first two months after surgery may jeopardize the healing of your bones. You should exercise extreme caution during all activities, including walking, until your physician determines that your bones have healed.

Maintaining aerobic cardiovascular fitness has been an effective method for preventing the progression of osteoarthritis. Light, daily exercise is much better for an arthritic knee than occasional, heavy exercise.

When you have arthritis in your knees, it is especially important to avoid suffering any serious knee injuries, like torn ligaments or fractured bones, because arthritis can complicate knee injury treatment. You should avoid high-impact or repetitive stress sports, like football and distance running, that commonly cause severe knee injuries. Depending on the severity of your arthritis, your physician may also recommend limiting your participation in sports that involve sprinting, twisting, or jumping.

Because osteoarthritis has multiple causes and may be related to genetic factors, no simple prevention tactic will help everyone avoid increased arthritic pain. To prevent the spread of arthritis, physicians generally recommend that you take the following precautions:Avoid anything that makes pain last for over an hour or two.Perform controlled range of motion activities that do not overload the joint.Avoid heavy impact on the knees during everyday and athletic activities.Gently strengthen the muscles in your thigh and lower leg to help protect the bones and cartilage in your knee.Non-contact activities are a great way to keeping joints and bones healthy and maintain fitness over time. Exercise also helps promote weight loss, which can take stress off your knees.


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