KNEEtalk

The WAITING ROOM => Emotional/Spiritual help and encouragement => Topic started by: rightmeow on July 04, 2013, 04:37:40 AM

Title: Injuries and depression
Post by: rightmeow on July 04, 2013, 04:37:40 AM
Hi,
Wondering how others cope with depression when they have an injury. I had a TTT 10 years ago and am experiencing knee problems for the first time since and have a lot of anxiety about my future quality of life. There is a chance that the problems I am currently experiencing could be long-term, though I am currently in PT trying to see if this will help. It hasn't so far.

The thought of having longterm knee issues after all that I have been through is terrifying to me. I have a history of depressive episodes - after my TTT 10 years ago, I had a deep depression and ended up hospitalized. I had a lot of traumatic life experiences during that time as well and I may be experiencing some form of PTSD, living through knee problems and immobility again. Since then I haven't been on meds for years and have had a manageable depression.

Now I feel like it's back in full swing. I cry almost every day, lamenting over all of the activities I can't take part in (most of my hobbies involve activity of some kind). Especially going out with friends at night - I have had to completely stop going to dance parties. I also work in a fashion-conscious environment and can no longer wear heels/fancy clothes, as I need to wear comfortable shoes with my orthotics - even small things like that take a toll on me. I also can't stop thinking about my poor cat that passed away two months ago. I'm worried that by the time I'm 40 I'll have a horrible quality of life due to knee problems. I am only 28.

I do have a few pluses in my life - a fantastic boyfriend (who is starting to get sick of my depression), a loving family, the fact that I have a job (even though I hate it)...but I'm still extremely depressed. I need to take medication to go to sleep these days since I am so upset.

How do those with a history of depression get through injuries like this? How do you reconcile your quality of life, the realization that you're not "special" and going to heal just because you want to? There is no silver lining, no one watching out for me in the stars, and possibly no solution to my problems. How do people cope with this and live happy lives?
Title: Re: Injuries and depression
Post by: dm on July 04, 2013, 06:30:30 AM
Simplest answer I can give you is that it's up to YOU to take some action. YOU know how you are, YOU need to do something about it to change your attitude about the situation, and to develop a more positive outlook about your life. What's the saying - you can lead a horse to water, but you cannot make it drink.

We all have to deal with the situations we have, and the bottom line is that it flat out sucks sometimes. I have a knee that's shot, and have been at the stage of needing a TKR for about 3 years. Have not been able to do so the last year because of $$, also have had to contend with doc who wanted to do minor op, to fix what I consider secondary problems, but not fix the major issues, because of my age - I refused to let them put me through a surgery when it wouldn't result in reducing my pain or improving function, in the end - to me a waste of time and money. Sucks big time. The only way it'll get done at this juncture is if the knee becomes so bad that the doctor decides that it HAS to be done, there is no choice and that the surgery is no longer classifiable as "elective". Totally sucks. I also won't let them operate on my knee again without clear benefit to me - if I'm gonna be in just as much chronic pain after, what's the point?

SO.... as you can see - I also have reason to get depressed. BUT I CHOOSE to do everything that I am physically able to - and frankly - things I shouldn't (which I pay for in pain and disability recovering) but I refuse to let my knee be a complete ball and chain and ruin my life. Yeah, I admit, I catch myself "emotional -eating" and "medicating" with food, which does not help my knee at all - but I admit this, which is a small step in trying to manage this problem.

I am not in your shoes, I have never been "pretty and athletic" so I cannot advise on your predicament, I can only say that I sympathize, and I can understand where you are coming from, and if you want to chat with someone who understands, you're welcome to reach out this way. I can listen - I'm good at that - you'll at least find a sympathetic, non-judgemental ear here if you want one.

What do I do about this you ask? I'm in chronic pain daily, which as you know is miserable, and adds to the depressive issues. And, as you know, everyone gets tired of hearing about pain complaints. Well--- For starters, I do everything I can to manage my pain and not let it manage me. Everything you can do to keep the pain from getting out of control makes it easier to keep tolerable.

I use icepacks, local anesthetic patches, tens unit, topical painkillers like diclofenac, over the counter painkillers, heating pads, hot baths and showers, prescription painkillers, etc, to manage my pain. I try to start out with the lightest weight painkiller I can use, and then go up from there. Things like icepacks, the anesthetic patches, the topical painkillers, etc, can all allow me to reduce the use of the narcotic prescription painkillers. fortunately, I am not at the top of the scale on those, I use those when the other methods are inadequate, so that when I'd be taking 3-4 of the heavy pills alone, I can use less than half that, because I use the other methodologies in combination with them.

How to deal with the things you want to do and cant tolerate in long stretches? Brainstorm, see what you can do to develop accommodations, such as using doubled up ziplocs and available ice at locations to make up instant icepacks - a rest sitting down someplace, and an icepack, can often revitalize you and let you keep going at an activity vs having to pack up and go home. Plan so that you can alternate periods of activity and breaks, instead of having the expectation of standing all night, then you can keep at a location longer, this is how I handle things like malls - I shamelessly will approach a concession and ask for ice to make up an ice pack and sit for a while, then toss my improv ice pack and finish off what I wanted to get done. Heels - I have wide feet and big toes and cant stand heels, so I just don't wear them... I wear a flat shoe that goes with slacks, you can't get me in a dress! - so you'll have to get creative and come up with no-heel pumps that you can wear if you want to get dressy. Orthotics aren't a problem for me, so I can't advise there - consult with the place you got them, and ask if they have lower-profile versions for dressier shoes - you won't know if you don't ask!

So, anyway, enough of a novel here - as you can see - you have to decide that you don't want to give up, and rack your brain and gather your resources and get creative. Think on what I've said - and make up your mind how you want to manage your issues and not let it manage you. That you've brought up the topic says you're wanting to do something, you're just not sure how. Consider talking to someone with "real life" practical help options for you - perhaps a session with an occupational therapist may offer some coping ideas for the physical issues, and a social worker or psychologist for the practical head stuff (not just hand you a prescription)
Title: Re: Injuries and depression
Post by: TheGator22 on July 26, 2013, 11:34:13 AM
Hey i read this post and it got me very emotional and I feel for you so much. I hope everything works out.

Ive had knee problems for 5-6 years now which started when i was in year 10 at High school and now im  third year out of school and the pain has got gradually worse even after surgery.

I  first started getting problems with my right knee which was due to maltracking problems. I played heaps of  Football, Tennis and did competitive long distance running. After i started noticing the feeling and uncomfort of my right patella maltracking,  general soreness around the meniscus and under the kneecap the orthopedic surgeon sent me to a physiotherapist. The physiotherapist gave me a series of exercises that was aiming to ' loosen ' the IT band, strengthen the VMO and increase general flexibility. The physio told me to have a week off and that wasnt the right advice at all. I did have a week off but it wasnt enough. My pains still remained and they never suggested the idea of going swimming as swimming is the best exercise for weak knees etc.

The physio didnt work and my surgeon opted for a lateral release/knee arthoscopy where they released the knee tendon to get rid of the discomfort I had with the maltracking.

After this surgery it still hasnt been the same and my knees have actually got worse. its been two years since surgery and my knees feel worse than they did before surgery. I cant run any more without pain that begins where the scar is on the surgery. I get soreness under my kneecap on the left and especially the right side ( top of the fibia ) . I get soreness on my patella, my meniscus  and slight pain at the back of my knee.

The two worst parts is how red/inflammed my knees get and how sensititive/uncomfortable my scar is. If my scar gets contacted in anyway, my knee feels like it is bleeding inside and the pain unbearable. Ever since the surgery my right knee feels so much weaker. It feels like there is something missing and there is a hole where my scar was. WHAT ARE EVERYONES THOUGHT OF THE SITUATION ??? HOW DO I GET RID OF THE SCAR SENSITIVITY AND GENERAL PAIN ? SWIMMING ?

I recently had an MRI and it came up with these two results. It said i had  moderate thickening of the patella attachment of the patellafemoral ligament, a small portion of which extends into the lateral aspect of the patellofemoral joint.  The Adjacent soft tissue/Hoffa's fat space oedema. Ive seen my second surgeon about what showed up and he thinks it could be a ' Nerouma Nerve ' issue that is irritating my wound. He told me that he wants me to tap on the scar for 4-5 weeks and if the pain goes away then no further action needs to be taken on fat pad and patellafemoral ligament. I've been taping on it for a two weeks and i havent noticed much improvement at all. He said if it doesnt work and the pain is still present,  he will inject local anaesthetic and steroids which will ' hopefully ease the pain '. He was talking about getting the hamstring graft and reconstructing the medial patella femoral ligament. MY MAIN CONCERN IS THE HOLE AND WEAKNESS/ANXIETY i feel on the scar and around it. WHAT IS EVERYONES THOUGHTS ??

Also my left knee is having maltracking issues aswell and its at the stage of my right knee 3-4 years ago. What is the best way to go about treatment for it ? Is taping the patella constantly a good idea ?

Also my mental state is becoming a huge worry. From not being able to run and play  my love of sport has caused a complete breakdown. I have developed bad anxiety issues, extreme depression where i contemplate suicide ocassionally because of the pain i feel and none of my friends understand and take it as a joke. They mock me when i complain about it and dont realise I cry everynight because of it. I find it hard to concentrate and be comfortable in a social situation because im constantly worrying about it and the ' scars hole ' makes me feel nervous and anxious. I really need this pain and alignment problems to go away. SOMEONE PLEASE HELP AND GIVE AS MUCH ADVICE as you can because i dont know how long i can last.

And rightmeow about the dance parties i feel exactly the same. I cant go out to a dance party because im overworried about my knees which always become sore. All my friends who  are 21 go out every saturday and Im jsut left at home. No one understands what it feels like and not being able to go out. I cry everynight just like you and wish i could go for a 5km  run again. Im never going to give up hope but it gets harder and harder everyday. Im currently just crying now writing this because i just find it so hard to keep going.

Lleyton Hewitt the Australian tennis player was told by 4 doctors he couldnt play professional tennis again but he ignored there advice and went on .  He had four toe surgeries and went on to beat the 11th player in the world at Wimbledon. Never give up hope


Hope you are okay rightmeow :)

Title: Re: Injuries and depression
Post by: dm on July 27, 2013, 12:36:16 PM
I understand how you feel. I know you may not want to consider this, but I would really recommend you go talk to someone about your anxiety and depression. They can offer you some ideas on how to cope inside your head, and if they feel you need it, even meds to help you control the symptoms.

As for your knee, if it being hypersensitive is a real killer and they want you to try "desensitization therapy" which is what the tapping on it sounds like, perhaps putting a wand on the shower head if you don't have one, and using that on one of the heavier settings would give you the same effect while providing the heat of the shower to bring blood flow to the area at the same time. Just a thought.

To help you cope with the area not being able to stand much contact pressure etc, has the doctor suggested trying local anesthetic patches? there's a patch called Lidoderm that might be worth trying. It's not a shot, it's a transdermal patch you wear for some of the day, and the patches can be cut in size, so if a small square works instead of the full size patch - it'd be a plus for you. Maybe it's worth asking to give them a try, to see if using them for the daytime hours may help give you a more normal life by cutting down on the constant "ouchies" while they work to figure out how to handle the mechanical issues.

Instead of taping, perhaps a sleeve brace with a "donut" to help keep the kneecap where it belongs could work - or have they tried that and it didnt?

Whatever you do, don't let them do a lateral release on the other knee- that was obviously the wrong course of action with the first one - so if the other knee is going down the same path - makes sense that the LR is not gonna fix it. Corrective surgery to undo the LR on the bad knee may unfortunately be needed to help sort your issues. Haven't been there myself, but have seen posts here where others have had to have that reversed.

I'm sorry you're having such a rough time, and I don't know what else I can say other than to sympathize and to tell you that I do understand, even though my injuries are different.

One of the things I've had to do is to think about myself pretty hard, and to find other things in life that make me happy. I cant mall-walk and window shop for hours like I used to do - I found it fun to go wander the stores at the mall for the day on the weekend, and not spend hardly any money, but I can't spend hours and hours just simply walking anymore. I have to plan things that will allow me the opportunity to take breaks when I need to, and I also have to "plan" and do things like take pain meds in advance of certain things, else I know I'll be feeling it even worse later. That's one trick I learned having dealt with so many surgeries and with therapy - if you know you'll be in a situation where your pain levels will be increasing -such as going to physical therapy - or spending the afternoon out mall-hopping- then taking pain meds just as you're getting ready to go prevents the pain from spiraling up to the point that you're miserable. Waiting until then to take anything - even ibuprofen - makes it that much harder to get the pain managed so you can get on with what you wanted to do.

It may seem silly, but I do stuff like keep a box of quart size zipper bags in the car. then, when I need an icepack, all I need to do is stop someplace that has an ice machine and ask if they'd please let me have some. I've never been refused. I double up the bags so if one leaks, it'll leak into the other, and can just ice my knee as I drive or whatever. I keep an elastic wrap I can reuse tucked with the box of bags, so i don't have to hold my improvised icepack.

I've also had to find other activities I also like to do that aren't so physical or cost much...and that is something anyone, of any age or ability should do, because you never know when you'll break a leg or something and not be as mobile as you were... and you've got to be able to cope and keep the mind busy.
Title: Re: Injuries and depression
Post by: TheGator22 on July 30, 2013, 02:46:41 PM
Hey DM thanks for the reply it actually means so much .

None of my friends or even my family understand what i go through everyday. I find it hard to socialise because I get so anxious and then I start to freak out and get sucidial and emotional .

Firstly with the sleeve brace I remember i  bought one for like $300 and it was not to bad but just normal elastoplast tape helped as much as the sleeve brace donut thing did. The only thing with the Elastoplast is it become irritating on my knees. The biggest problem  with my right knee is obviously the scar. I feel so much weakness around the knee area and it feels like the scar is the cause of all the weakness. I have soreness all around the the knees ( kneecap , meniscus, under the kneecap, everywhere ) Ive been trying to build up the VMO strength on the right knee but it still seems my knee is getting extremely inflammed and sore.  Ill continue to try build it up but it feels like all it extremly bony all around the knees and there isn't much muscle growing.

First question I would like to ask is when you talked about the operation to correct the lateral release ?
What did others say about correcting the lateral release and its process ?
My second orthopaedic surgeon  talked about reconstructing the patellafemoral ligament with a hamstring graft but wanted me to do the taping of scar first. My first orthopaedic surgeon talked about doing a series of cortisone injections,  a scar tissue operation or back to physio. Not sure which one to go to.
Also what do you think about Acupuncture ? I heard it can be successful as it twitches the muscles etc.   

Secondly you were talking about Local Anesthetic Patches ? Where can you get them from ? and how much do they cost ? Are they fairly successful ? I am keen to give them a try

With my left knee there is definitely patella maltracking should i  keep trying to loosen the IT band ? The VMO is fairly strong.  Is there any suggestions regarding physcial therapy exercises or things i could do ?

The problem with me doing activities that any age or anyone can do is ive just never been like that. Ive always been so active and been so comfortable playing sport etc. Thats why i hate not being active because when I'm not i feel like i should be and i get really stressed/anxious etc. I want to be 100 per cent injury free and active again like i use to. DO YOU THINK ITS POSSIBLE ?

Last thing is swimming ?? Do you think that will increase my mobility ?

Thanks for replying again it means so much . My email is [email protected] if you w3ant to contact me there.

Regards.

Sam   
Title: Re: Injuries and depression
Post by: dm on July 31, 2013, 01:20:02 AM
The anesthetic patches are called Lidoderm, and they're prescription. Ask your doc if you can give them a go.

I can't advise on the LR reversal, never been down that road, suggest you search the board postings and see if you can find some commentary from others about it.

Talk to your physio, or even consider seeking a consult from a physio who's never seen you before, who comes with good recommendations. The reason I suggest this is that for the therapy stuff, sometimes a fresh perspective can bring some new insight to the situation, same as seeking a second opinion from an ortho consult.

Consider consulting an occupational therapist, their goal is to get people functional - the outlook is a bit different than perhaps a sports physio. might give you some different insight to ways to help the injuries.

I've had muscle stim for a crappy vmo before, some low-level stim may be an idea to de-sensitize the crappy area, or to help get some muscle action going, or to provide assist while you work the muscles on that leg yourself - some therapists do this, some don't. may or may not be an option for you with the hyper-tender problems. Just thoughts running through my head.

Keep searching for answers... maybe I've given you a couple ideas... you got lemons... make lemonade.