terrible awful no-good very bad knee

[mdk]

There is no reason at all to mark May out as a target.

Well -- no medical reason, no. I know that (or at least I SHOULD know that, sometimes it feels like I forget). But for the purpose of getting back into military flying, May is kind of a big deal.... Or was, I guess. It's not gonna happen. But I suppose there's no sense in worrying about it now, because even if I COULD rush things to meet the arbitrary nonmedical deadline, it still wouldn't be a good idea. Just gotta lay back and throw myself on the mercy of the system. We'll just have to wait and see.


Update, or what passes for one.... nothing really progressing very much, which, again, pretty much expected by now. Trying some weight-shifting exercises at PT and they're still awful, but not quite AS awful, so there's that. Heel Slides are, well, my achilles' heel -- going too far past 90 causes some nasty popping that nobody likes very much, myself included, so I've been instructed to back off on those a little bit. I'm not calling that negative progress, because I don't want to -- but I probably could. The good news is I've been getting more active at home and at work.... bad news is there's been a corresponding rise in afternoon/night pain, which obviously means I need to slow down even more than I already have. So, I'm abandoning (for now) thoughts of getting rid of a crutch anytime soon, and embracing the snail's pace. I don't know what this does to me professionally now, but let's be honest, profession is second to health.

Oh -- other good news. New pads showed up at the end of my last PT visit, so I at least have those to look forward to. Getting zapped tomorrow. Awesome.


Edit: Just kidding, they only got ten pads, and they're out already. So no zapping. Instead, I got a lot of weirdly concerned looks from pretty much everybody in the clinic, and a long heart-to-heart from the chief person in which she discussed how "there's really nowhere to go from here," and talking about looking into taping and bracing as "theoretical" options to get over the initial hump of atrophy. But it was presented about that enthusiastically. Yeah. Things are.... things are looking not great I guess.

[TOMMAX]

Man that is a bummer. Youre right though that health is more improtant than profession. But there also needs to be a source of income. Id rather be homeless and healthy than rich and sick though.

Im sorry to hear about the quad and leg atrophy and can say I truley empathize with you and know how you feel. It sucks man but theres got to be a solution.

Hows the pain? Where do you feel it the most? Is the quad firing at all?

Im right here with you, riding it out, hoping for better days, trying to stay positive.

How did you initially injure your knee again?

[Brambledog]

Hey mdk,

Sorry things are still no better, completely understand your frustration and feeling of being left behind with all this crap to deal with. All you can do is keep plugging away at those exercises and hope that something improves soon, also keep slugging at your docs so that they don't file you under 'W' for We Can't Be Arsed. Grr.

The quad thing is horrible. Mine is still not paying ball properly, starting to wonder if I will ever get back full (ish) use. Just never give up mdk. Try and be positive (not easy) and i hope you get a break soon.

Take care now.

Brams 

[mdk]

Just capped off another week of basically zero progress. Today the heel slides went poorly enough that we just called it a day and put ice on the thing, and even THAT was killing me. On the bright side I didn't have to go back to work afterwards. The one doc is allegedly calling the other doc and trying to figure out where to go from here... On the plus, SLRs are still doable in 3/4 directions. The funky, cross-the-good-leg-over-and-go-to-the-inside one isn't really working out as well, but that's not a huge concern for me. The concern is that once again, bringing ROM back into the protocol is what's killing me. I *cannot* do the bike anymore, and the heel slides are hellacious. This is exactly the same pattern that happened with the previous surgery, if not quite as intense as before. Then again, I basically had to CRAWL back to my car after PT today, which, you know, that's not exactly "mild."

How did you initially injure your knee again?

Unarmed combat, which sounds way cooler than it is. Basically in a training program we do little mock-fights (which are really, really dumb), and I, being really really dumb as well, got a little too "into it." I was jumping towards a guy and realized too late that I was gonna land right on his face, so I sorta twisted away and landed *directly* on my kneecap. At the time nobody felt like taking me seriously so the Air Force outright refused to deal with it, so I just sorta shrugged and went along with it. Three and a half years later, I'm starting to regret that.

Hows the pain? Where do you feel it the most? Is the quad firing at all?

When the pain is on, it's *on*. Not quite fall-out-of-your-chair intense, but about as close as you can get. Still, I've weaned myself off the painkillers and so far I'm still trying to keep it that way. It's about 80% up front -- can't really get more specific than that, because it feels like trying to find the exact spot of the crater where the A-bomb exploded. The whole thing is a bombed-out crater. But yeah, pretty much local to the kneecap. When I'm "walking" (still on both crutches, btw) it can permeate the entire knee, with some popping and grinding coming from pretty much everywhere, or at least that's what it feels like. Once during PT the tech was poking around the lateral side of my leg, like where the outside tendon lives, and that thing was on *fire*, but that's not happening all the time. So, I'm at a loss. Everything hurts and I can't fix it -- standard 

[Brambledog]

Mdk, it sounds horrible, and there's undoubtedly a chance that something's not right if you still have so much pain and mechanical problems with that knee.

I admire that you've ditched the painkillers, but given all your problems with the PT and just getting about, you really need something to make things easier. If you've got bad pain, that's what painkillers are there to deal with. They come with issues, obviously  but taking no painkillers when you're in so much pain is making life so much harder for yourself. No offence intended, but pain is never good, you know that too well, and your doctors should be dealing with that properly.

Hope for better news soon...

Brams 

[TwoBadKneesUSA]

Sometimes too much pain can hinder progress.  It is admirable to want to ditch them, but the intense pain can be making it difficult to progress.  Ask your PT about it.  When do you see your doc next?  Hope between them they can help you progress.  Frusterating I know.

Milly

[2cutekiddos]

I have just read your whole post, what a ride you have been on! I was curious to know why they suggested a Fulkerson for you? I hope your PT's and OS can figure things out for you soon. ...oh and estim is overrated, or at least it was for me... I HATED that thing! Sending healing vibes your way!

Andrea

[mdk]

I was curious to know why they suggested a Fulkerson for you?

The surgeon made a much longer, more detailed, more convincing case in person, but what it ultimately boiled down to was bad lateral maltracking that didn't respond to conservative treatment or LR, caused obviously by an acute sports injury. And the TTT absolutely HAS helped with the pain -- or at least it did. I couldn't really say if the pain right now is on par with the interim period between LR and TTT, but up until these last two weeks or so it's felt a whole lot better.

I got PT again tomorrow and a follow-up with the actual therapist on Wednesday. Allegedly she's been in touch with the surgeon's office to figure out our next steps, so hopefully we have a new direction by the end of the week. I'm still stubbornly refusing to take the pills, which, I kinda laugh at myself, but I figure at least this way I'm not losing. I'm not winning either, but I'm not losing if I don't give in and take the pills. Stupid, I know, but for all the test scores I'm really not all that smart. There is SOME good news lately.... found out about a month ago that my dog has severe heartworms, and things were looking bleak for a while, but he's responding to his treatments a lot better than I am and his business is starting to look pretty promising. So I got that, at least!

[TwoBadKneesUSA]

With knee issues extreme cases of stubborn can come in handy.....  It all up to you if you want to take them or not.  So if you are not losing any ground, then that's a plus in my book.  Sure hope something can be done, but this may be just one of those that takes longer to get better.  Hard on the person doing the gettng better, 'cause it sure needs to move faster. 

So sorry your dog was so sick, that is difficult.  Glad they could treat him and he is doing better.  Our furry buddies sure help keep us sane (at least mine do).

Good luck Wednesday.

Milly

[mdk]

*headdesk*

Good way to start, right....

1. PT didn't call the OS at all. Conscious decision -- not forgetfulness -- because she "wanted to see the range of motion for herself." Which she could've observed a week ago.... ah well. Whatever.

2. ROM is locked in at 119-122. At that point I feel (a) a physical block, like a wall, (b) really really tight across the front, and (c) pain that grows for as long as I'm bent. Anything past about 75-90 triggers the latter two, but it's only the max-angle that REALLY gets them going quick.

3. During extension after a bend past 75-90 degrees, there's that loud and painful click same as I had last time. *Almost* every time, *almost* without fail. After two or three consecutive we tried taping it to force it to track better -- no dice.

4. I'm getting in trouble at work for -- quote -- "having a lot of medical appointments." I found out from a receptionist that my boss in fact called the PT clinic to see if I needed to have so many visits scheduled, or if I was just trying to dodge work. I may have pointed out that literally everybody else in the office spent two working hours "in the videogame section of the BX" today, but I didn't want to sound snippy. I keep getting tasks that require me to get up and hobble to one end of the building or the other; if I ask anyone for help I get eye-rolling or snarky comments, or "We need to talk" discussions from my boss. ......okay, I'm starting to sound like I'm over-selling this. Compounding everything though is the pain..... my desk is right next to the door and we're in a temporary facility, which means the floor shakes whenever anybody walks by. Well a lot of people come and go from our office and *every time*, I'm shooting up to 7's, 8's, and 9's. But I can't switch to a different desk, because "We need you there so people who come by don't bother us."

Well, you get the point. Work sucks.

5. I've learned (medically now, sorry for that rant) that "You're not progressing the way we want you to" is the same thing as "You're not progressing." I've also learned that "Do you want to take a break from PT?" is the same thing as "We can't help you," and "Would you consider another surgery at this point?" is code for "This isn't gonna get any better on its own." In a chilling moment, she asked me "What do we even do from here?" I joked "Cut it off?" and she became deadly silent. But then again, maybe I wasn't joking.... I honestly don't know how much longer I can do this for. I have to physically drag myself from one place to the next; any weight-bearing I get is purely coincidental, as a walking motion produces pops, clunks, slides, and of course pain. I'm wearing through my third set of rubber crutch-bottom things; random passers-by stop and ask me if I'm "going to be okay there." And of course I'd have to be denser than..... something.... really dense.... Lead. I'd have to be denser than lead to think that any of this was compatible with a career in the military, let alone military aviation (let alone AFSOC aviation). So my hopes are..... dwindling..... for that anyway. As gloomy as all this sounds I really am staying positive -- I do not need this job. I DEFINITELY do not need my little bs interim-we-don't-know-what-to-do-with-you position. If "the worst" comes to pass I'm *fine*, other than the knee. Speaking of, I missed a bullet....

6. Weight-bearing makes my knee turn purple. ONLY weight-bearing, and only once that I noticed (then again I'm usually wearing pants); and when I take the weight off the color rapidly returns to normal. No noticeable temperature difference -- so I still don't think it's "that." But I brought that up today, so hopefully it gets forwarded along this time. This time she *promises* she's gonna call the OS. I can probably put a lot of stock into that.

[kneepaincure]

Hi mdk,

You really are going through a trying period (to say the least). I don't know much, but have you spoken to your doctor about the possibility of having arthrofibrosis? (Don't know if you've mentioned it in any of your posts) It was the locked ROM that made me think of it. There is a section on it here on Kneeguru that you could read and see if it matches your symptoms. It's something that always needs to be treated a.s.a.p.

Stay strong!!

[Lottiefox]

Sorry if I have missed this in the thread, but have you had an X-ray as follow up after the TTT to check bone healing? I am assuming they have actually checked that the TTT site is knitting together as it should do? There is a poster on here at the moment who has had issues after a TTT and an X-ray at something like 15 weeks has shown lack of fusion between the shifted part and the tibia. Just a thought - that would sure cause pain but not sure about the block sensation. As mentioned, you definitely want to raise the theory of AF as well, as there may be something like that going on, or it might be your tracking is just not functioning as it *should* do with the new alignment because you have so much muscle weakness - I am not sure of how to establish if its muscle weakness or still the wrong tracking line....

I'd be VERY wary of anything else surgical being suggested until you know what is underlying the current problems. Do you have any way of seeking a further opinion on all of this? Even if you could get your history, scans and current presentation sent to a PF specialist it might give you direction. Whatever happens, don't be told there isn't anything else to be done. There isn't a magic wand (if there was, I'd be patenting it and making millions) but this isn't right and you don't deserve to be left floundering around with no attempt to find some answers.

Hope you get some progress with the OS conversation.....this really does suck.

Lottie

[mdk]

Yeah I did get some X-rays done at 4 weeks, and at the time bone healing was "not yet complete." But they predicted just 2-4 more weeks and it should've been done.... I know I know, predictions are worth their weight in pocket lint, but to be fair the pain I'm having now is pretty distinct from the pain I was having in that period. That was very much localized to the bone site, where now it's p in/on/around/under the patella. Still worth checking out, and I imagine if (when) I get my accelerated follow-up with the OS, they'll do some additional x-rays.

My gut reaction was to say "Let's get an MRI," but of course there's screws in there now, so that wouldn't go so well :/


It occurs to me that I've never had a "rotational CT scan" done after all this time. Is that something I should be looking into?

[Lottiefox]

When my patella issues were checked out I had a series of funky MRI scans where a nice man calculated with extreme precision the size of my bald patella areas. I also had a CT scan on tracking - this wasn't rotational but looked at the tracking of the patella at 0 degrees, 15 degrees and then 30 degrees of flexion. These are the key bits apparently and I had to have scans done with quads tensed and quads relaxed. This showed that I had tilt (and how much it was tilted), and how the patella shifted laterally and how far. It also measured the depth of the groove, the distance between tendons and bones and attachments and stuff, and something else that I forget but that was considered quite helpful to the surgeon at the time. On the basis of those he said I didn't need a TTT, but I did have tilt (perhaps I might benefit from a LR) and did have extensive bald spots on parts of my kneecap (I am aged at 43 and spent my youth falling out of trees and onto ice rinks...). He was very honest that the LR might just shift the worn spots to other areas. Where I have been saved is that my groove bit has some covering so I am kind of grinding along in a state of flux for the time being (no impact sports - me and the spin bike are big mates).

I would certainly be asking if they can get some form of information that shows what is going on in your tracking at similar stages. You mention this block, is this because of extreme "shift" or is it AF? The TTT doesn't preclude an MRI (your knee won't explode) but it makes reading it difficult as there will be a lot of interference....

Have they ever told you what state the patella surface is in? Apologies of you've said this already back in the thead? I am wondering if you have some damage under there and that is now problematic with your new alignment. I don't know though, we can only ever make educated guesses...but the more questions you have the better...

Good luck with the accelerated follow up. Oh and good news on the dog BTW too. Animals are a darned site more reliable than knees methinks.

Lottie

[mdk]

The wonderful system at work again..... Got my next appointment set up for next thursday. Talking with my PT I found out there was an opening tomorrow (to which I would have said "YES YES YES YES PLEASE GOD YES"), but the PT thought it would be too hard to get through all the red tape to forward my own medical records to my own doctor. Sad thing is she's right -- last time I did it two weeks in advance and the TriCare office still never sent anything. Vote no on AHCA, people.

Anyway today was another in a series of bad ones. I actually have a headache from squeezing my eyebrows all day. Best part was when for about 2 hours straight, my right leg was killing me -- similar symptoms too, like a painful pop and tightness anytime I flexed it past 90. I'm figuring I've been on crutches for almost 8 months straight now, this was gonna happen sooner or later.