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Offline stoplimping

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Need help understanding and explanations needed.
« on: October 23, 2005, 02:37:39 PM »
I wonder if you could help me with a knee problem I am experiencing.

In 2002 I had a car accident that resulted in my left knee being very swollen and I wasn't able to weight bear. It was not painful just very swollen. X-rays showed no sign of fracture and it was splinted straight.  I then was discharged but have intermittent swelling and pain through the knee and down the calf of the left leg.  This left me with a limp. A Dr said I had tenderness to the inside of the knee, on a tendon.

The surgeon, done privately (semi-retired), reported this: I had a dashboard injury and this was what he did during an arthroscopy in 2004.

Nerve block injected into the left knee sciatic/femoral nerve and an injection of steroid.  EUA revealed a stable knee.  Arthroscopy revealed a 5mm wide strip of Grade III-IV fibrillation right across the medial facet at the junction between the inferior and middle thirds.  There also was a 10mm wide strip of surface abrasion on the medial femoral condyle front-to-back at the junction between middle and lateral thirds.  Medial and infapatellar plicae were divided.  120g Depomedrone was injected after washing out the knee. A physio said I had degenerative knee disorder but nothing more was ever said or was it mentioned again.

I had limited physiotherapy, as they sent me back to the surgeon.  He then in December preformed an aspiration. Again limited physio before again being sent back to the surgeon, as they could do no more. It was mentioned I am in pre/post(?) op mode not rehabilitation mode? He then said that until 2007 he would not know if this procedure had worked fully and to see him then or sooner if things got worse.

I have pain in both sides of the knee, tendon pain?, stiffness, pain in the bones, the knee gets hot, it gives way, is unstable on rough surfaces and feels very unstable. In cold/wet adverse weather the pains increase. The knee swells up and the leg is swollen also, fluid appears to build up as my ankle vanishes in a puffy mass. I have pain in my calf, which feels like severe cramp.  I also have muscle weakness surrounding the knee.  I cannot kneel down on it, as it is very uncomfortable and painful not forgetting I have no strength in pushing myself back up from it.  I can bend the knee, sometimes not very much others as would appear to be normal function, straightening does not fully straighten.  It is very stiff if I sit or I am stood in a position for too long.  The leg/knee/muscles shake at times, normally when under stress.  My gait is altered and I favour the right, heavily, which is now showing signs of selling and stiffness. At night my knee is very uncomfortable, I find some relief in placing a pad between it and my other knee, but not always does this work.  Occasionally I find I walk like a cowboy as best as I can describe it. I have also developed problems with my lower back.  When it is tired the left leg drags, sometimes slightly sometimes a lot.  I also have numbness on the left leg in places and it does not feel like the right, although recently the right is also appearing to deaden.  The knee itself also judders and clicks and cracks, this can be from walking down the stairs to just moving it.

If anything the operations made the knee condition worse it certainly has not improved it any.  I have physio who was for my back but she kindly took over my knee to help it at the same time.  We do limited exercises.  I have had another MRI which was clear, alleged by another Dr.This was via the NHS. Who also disputed a member of his team for seeing the knee swollen with fluid, as also verified by my own Dr before and after this visit.  This Dr said I need decent physio but did not elaborate further and to see him again in November. It is now 14 weeks and still no physio from his side of things.  My confidence in him is non existence, he gave the impression he made him mind up before hand and that was it. Nothing I said made any difference.  I would not be surprised to be written off when I see him in November.

My original surgeon also said a full knee replacement, which was one of his solutions might not help me?  Any idea why, other than I am only 39 years old currently?

What does also this mean and is this is my knee will always be like this?  I just don't know what to ask or what I should be getting and it is now getting me very down.  If you could help, advise I would be eternally grateful. :'(



Offline stoplimping

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Re: Need help understanding and explanations needed.
« Reply #1 on: October 23, 2005, 02:55:48 PM »
Sorry forgot to add this.

I have severe PTSD this the NHS Dr blames for everything. No matter how I try to get it through his head, that the symptoms are physical and not mental and are not connected.  ::)Likewise I have a very high tolerance for pain and effectively manage it, it falls on deaf ears.  As my other Dr (CBT) has said the PTSD is nothing to do with my knee problems. There is also Gynae problems, cysts, that have been ongoing for 10 years, also told in my head no proven to exist. I was labelled as a chronic pain sufferer, which I feel was not appropriate as my symptoms were actual causes not mind related.  So I am fighting on all sides and not sure what or who is on my side or what to say to get the knee sorted out, if it can.

I can effectively deal with anything if I know that is it etc.  I also have a history of healing fast, and probably far to fast which may cause problems.  But I do know reality from stress, it still hurts to be subjected to people who should help you look to blame anything else than deal with the problem until further down the line.  Frustrated, you betcha I am, and I still retain a sense of humour.

If I was a horse they would have shot me by now.  ;D  Any help, advice much appreciated.


Offline stgiles16

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Re: Need help understanding and explanations needed.
« Reply #2 on: October 23, 2005, 04:48:41 PM »
It sounds like your accident was kind of like mine. My knee also hit the dashboard. This resulted in a tear in the medial femoral chondyle (the articular cart). You also have abrasions on your mfc . Did your OS do anything about them? They can cause some of the pain that you are describing. I too have to put a pillow between my knees as I have pain on the inside of my knee when it touches the other knee. THis kind of damage does not heal on its own. You need to find out if it was corrected during your surgery.
keep us posted.
missy
2 ligament recons right ankle
2 arthroscopic,
5 open knee procedures
2 Plica removals
bone spur removal
2 microfractures
4 debridements
2 open LOAs all on left knee
Arthritis,both knees, ankles, shoulders, elbows, hands,spine
Fibromyalgia
Arthrofibrosis
LOA & PKR 2/15/06
RA
in pain mgmt
TKR JAN 2012

Offline med1

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Re: Need help understanding and explanations needed.
« Reply #3 on: October 23, 2005, 05:41:18 PM »
You also indicated that your OS told you it would be 2007 before he would know if the procedure worked.  Didn't that send up a red flaming flag?  Did you know this is 2005?  Sounds like he just didn't know what the h.. was wrong or is too inexperienced.  Any way you look at it, he is definitely not helping you is he?  Doesn't sound like he wants to either so how about another opinion or a another if not happy with treatment.  You know, there are some surgeons out there that are the only ones in the field for sometimes a few hundred miles that actually are the experts.  Do some searching, find an expert, you deserve the best and sometimes that is the only way you will again be pain free and normal.

mini

Offline stoplimping

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Re: Need help understanding and explanations needed.
« Reply #4 on: October 24, 2005, 07:27:07 AM »
It sounds like your accident was kind of like mine. My knee also hit the dashboard. This resulted in a tear in the medial femoral chondyle (the articular cart). You also have abrasions on your mfc . Did your OS do anything about them? They can cause some of the pain that you are describing. I too have to put a pillow between my knees as I have pain on the inside of my knee when it touches the other knee. THis kind of damage does not heal on its own. You need to find out if it was corrected during your surgery.
keep us posted.
missy

Hi Missy and thanks.  As you can gather I know near enough zero what happened other during the arthroscopy and aspiration than the bit I posted which was a copy of a letter sent to my GP. Which is why after all this time I need some sound advice and a fair bit of explaining what is what etc; as I am fed up and frustrated by the whole treatment I have received so far. Not knowing what to ask or how to explain things to what I have deemed a very closed minded so called professional. That is not the PTSD side of me talking either, that would say far more in a stronger negative tone. :'(

 I don't understand the terminology or what bits are what other than, the kneecap and two leg bones; very basic indeed :-[. This may mean something to you or not.  I was shown a picture of some white object from the arthroscopy it looked like loads of white feathers, very pretty but not normal. I presume this is the protective layer that helps the knee move?  I also know there was debris that was removed during the washout.

I am going to ask to see my entire notes from all Dr's and hope they enlighten me some more, but I think probably not.  The first Dr didn't make notes or at least writes the briefest notes from what I have so far come across dealing with.  Today I am going to ask my GP for a referral to somebody to look at both my knees.  She won't like it but I feel enough is enough.  Plus I am going to ask to see the original surgeon as again enough is enough.  I'll also try to curb my temper while doing it.

Offline stoplimping

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Re: Need help understanding and explanations needed.
« Reply #5 on: October 24, 2005, 08:05:48 AM »
You also indicated that your OS told you it would be 2007 before he would know if the procedure worked.  Didn't that send up a red flaming flag?  Did you know this is 2005?  Sounds like he just didn't know what the h.. was wrong or is too inexperienced.  Any way you look at it, he is definitely not helping you is he?  Doesn't sound like he wants to either so how about another opinion or a another if not happy with treatment.  You know, there are some surgeons out there that are the only ones in the field for sometimes a few hundred miles that actually are the experts.  Do some searching, find an expert, you deserve the best and sometimes that is the only way you will again be pain free and normal.

mini
Hi mini.

Yes it did send up a red flag or six at the time.  But as I knew nothing about what was done or what was wrong I went along with what was said.  Now a year on from the surgery and nothing has altered except the right now is weakening the red flag of doubt is very much flying.  I also though maybe what was done was wrong but I don't know.  I would assume as he was by all accounts a good surgeon that he would not do unnecessary surgery?  I did find it very odd that both sets of physio ended the same way, being sent back to him as they could not do anything.  This has puzzled me more than what he did and what is going on with my knee.

My current physio acknowledges my muscles are weak, certainly from my understanding this would not help the knee.  Also when my knee is strapped up in a support bandage it feels WONDERFUL and I have confidence in it, certainly he pain lessens, the swelling however does not, or the burning heat sensation. Again I assume here that if my muscles gain strength the same effect should be felt of the strapping holding the knee more tightly?  Although I would not necessary say my muscles are that weak, but I am not a physio and so far I feel more confidence with her than the others.

The other Dr, is my second opinion and that was a bad mistake to use him.  He is supposed to be the top guy in my area which I very much doubt. As my psychologists stated, anybody who blames other things is not doing their own job correctly.  Which I agree with. PTSD can heighten pain, BUT, it can only heighten already existing pain not create one from nothing.  This, this so called, expert does not recognise and just blames it on something else then what already is there.  When he disputed his underlings find of fluid in the knee, but did say my gait is very altered, also verified near on constantly by my own GP as  fluid and swellings being present.  That raised more red flags than the wait until 2007.  Its says something when I am in more control, if that is the correct word to use, of my PTSD and more aware of it than I am with my knee.

As I see him again in November I want to be armed with, questions I should be asking and more understanding of what went on and not what the PTSD or a splinter in a finger have done.  Those are excuses not medical help, certainly make me question his so called expertise in the field.  He also unfortunately was the independent Dr who wrote a report for my case against the party who caused my accident.  Having read some of the reports I am not impressed and it became very clear he did not listen to me very much, other than name age etc.  This became more evident on my meeting with him, as my own Dr not the independent specialist, when he said he had good news or bad news on the MRI result and what did I want first.  I said the bad news first, and he said the MRI was clear, so I asked for the good news and he repeated the same.  At the time I was confused and it was until I got home it dawned on me what he was inferring.  All I can say is I am glad I was home as I exploded, what he meant was good news the knee looked OK, bad news for claiming money.  HE will be told some home truths and I would not be surprised to learn he writes me off. This is not about the money, this is about my knee and it being sorted out or knowing that this the  best it will be.  I can then get on with my life and make adjustments not live in the air of uncertainty.  No amount of money makes any difference or am I interested in that side of things.  I got my result when the other driver was prosecuted for dangerous driving , fined and had points added as well as admission of liability.  That is beyond monetary value.


It just gets me down having to fight for everything at present when I was the victim in this.  Since this has happened I have learnt some awful truths about the medical world. My view is not of a caring one at all, though I do acknoweldge not every medical professional is so anal and unsupportive.  Some of that view is the PTSD effects but the most part it is a honest observation of mine. :'(



Offline blackbeltgirl

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Re: Need help understanding and explanations needed.
« Reply #6 on: October 24, 2005, 04:53:18 PM »
You may have overlooked the good news/bad news aspect of a clean MRI.  If the MRI doesn't show what's wrong with your knee, it's not just bad for lawsuits.  It's bad for the doctor trying to diagnose your problem.  You are sitting in his office, telling him you're in pain, and the test he just ran didn't tell him why you were in pain.  WIthout knowing the cause of the pain, it's harder for him to help you get rid of it.  It's not just about the challenge it could cause in a lawsuit, but the challenge of diagnosing your problem.

As to your records, in the US you have a right to your complete medical records.  A lot of doctors take very brief notes during the exam, and then dictate more detailed notes into a recorder after your visit.  It is the more detailed notes that go into your medical file.  You should ask for your medical records from the doctors office, and for your surgical records from the hospital.  Your medical records may only have a summary report of your surgery, while the hospital will have the complete surgical records.

And if necessary, have yoru therapist speak to the OS.  Allow the psychologist to educate the OS on PTSD, so that the OS can't claim ignorance as his excuse.

Good luck.
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline stoplimping

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Re: Need help understanding and explanations needed.
« Reply #7 on: October 25, 2005, 08:39:41 AM »
You may have overlooked the good news/bad news aspect of a clean MRI.  If the MRI doesn't show what's wrong with your knee, it's not just bad for lawsuits.  It's bad for the doctor trying to diagnose your problem.  You are sitting in his office, telling him you're in pain, and the test he just ran didn't tell him why you were in pain.  Without knowing the cause of the pain, it's harder for him to help you get rid of it.  It's not just about the challenge it could cause in a lawsuit, but the challenge of diagnosing your problem.

As to your records, in the US you have a right to your complete medical records.  A lot of doctors take very brief notes during the exam, and then dictate more detailed notes into a recorder after your visit.  It is the more detailed notes that go into your medical file.  You should ask for your medical records from the doctors office, and for your surgical records from the hospital.  Your medical records may only have a summary report of your surgery, while the hospital will have the complete surgical records.

And if necessary, have your therapist speak to the OS.  Allow the psychologist to educate the OS on PTSD, so that the OS can't claim ignorance as his excuse.

Good luck.

Now that is something to think about. Teaching the OS about PTSD, I can just picture his face now and his dismissive attitude, but hey this should be fun. He has already decided, and I have this in writing in a report from him, that there is nothing wrong with my knee, based on the MRI and his not listening.  That is what I am up against. Which does make me laugh that he wanted me to have some proper physiotherapy before seeing me again to see if that helps.  Quite contradictory, if there is nothing wrong with the knee then the Physiotherapy would not be required. ::) He places the blame on the PTSD and making me to be some money grabber. I also think that because I saw him second his ego is also got a knock, hence the little snide remarks about proper physiotherapy.  His bedside manner needs to be re-learnt and as my GP said, they are by nature like that abrupt, rude, and dismissive.  To me then they should not be in the job they are doing, they are Dr's not Gods. >:(

Having seen my GP,  and asked to be refereed to somebody else far more experienced and I provided some names .  She decided to write to my current OS and explain that I am unhappy with his treatment, or lack thereof and give him a chance to resolve it or for him to call it quits and pass me over to somebody more competent.  Though she won't be saying the word competent, mores the pity. :D So its a wait and see until November until I see him again what will happen.

Having decided on returning home that I may as well kill two birds with the same stone, I rang and arranged an appointment with the previous OS who did the actual operations.   I go to see him  next week and hear what he has to say on this whole issue of my knee, and more about the 2007 twaddle. 

Now prior to that I took the bull by the horns and e-mailed some Dr's just to enquire if they could or would be willing to see me and seek some advice, not expecting anything back. I should hereby apologise for my negative attitude as two of them kindly did and agreed to see me, providing I get a referral from the GP first. They also told me what they needed so I am preparing for that and when I return to my GP in 2 weeks time if the previous OS stills stonewalls then a referral letter will be firmly asked for.

I am quite proud of myself, nothing major achieved but at least steps of the minor nature set in place. ;D No loss of temper either, I did roll my eyes though. :-[ It also feels great just to vent off the frustration, read others thoughts and problems and learn that bit more and not be so much in the dark that alone is priceless and has made my year.




Offline blackbeltgirl

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Re: Need help understanding and explanations needed.
« Reply #8 on: October 25, 2005, 01:27:17 PM »
Good for you.  The biggest lesson I've learnt from my own knee issues, and more importantly, from other folks here, is that the best thing I can do is be my own advocate.  Most patients aren't terribly informed, and assume that whatever the dr. told them must be correct.  As you start learning more about the knee, in general, you can take a more active role in your care.  It sounds like you've made a great start.  And it sounds like your GP is truly a physician - a healer - and will stick with you through this.

Let us know how things go.
Jess
ACI was supposed to be 2/21/06.  On 6/29/06 Insurance co said have another scope, and if it still looks good, they'll ok the ACI.
Microfracture Dec 7, 2004
   3cm x 6cm lesion, LFC; 3cm x 1cm lesion, trochlear groove; lateral tibial plateau lesion
2nd degree black belt, tae kwon do (had to stop)

Offline stoplimping

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Re: Need help understanding and explanations needed.
« Reply #9 on: November 04, 2005, 02:49:28 PM »
Well good news, well I think so.  first my physio identified I have a ducking problem.  Ducking means altered gait, which I knew I had, where by as I walk my whole left legs swings out to the side, from the hip,  and my foot is turned outward instead of pointing forward.  Now I have to walk , tall, and pull my foot. leg back into the correct walking position.  Not as easy as it sounds as I am unstable and I feel like I am walking with both feet  turned completely inward.  Walking correctly with the aid of my stick has eased some pressure of the right knee.  That was most noticeable bar the feeling that the left knee was being twisted right round.  I have a lot of exercises to do to strength the inner muscles of the left leg and hopefully pull the whole leg back into the correct walking position.  I must admit is is exhausting and painful walking correctly. :'(

Secondly at last physio bar OS2, the man who like to blame other things, arrived.   They noted that my calf muscle and some muscle on the outer thigh is solid, tight and rigid.  So I have stretching exercises to work it loose, no explanation as to why.  Also noted the swelling and crunching.

Now today I saw my original OS, who after listening said I need a lateral release operation. I had some x-rays taken he was expecting something horrid and they turned out to be better than expected.  There was some shadows on, I assume, the outer edge of the thigh bone,  and in the groove area, but the cap itself looked OK.  He still suggested a lateral release but would not guarantee it would work. He agreed my knee has shifted toward the outer side of my leg not in the centre and is slightly higher up than the right one.

I have the most pretty ink drawing over my knee. What is it with my OS who every-time he sees me draws on me? ;D

He did however say, I had degenerative knee disorder, which I have no idea what that is or what it may entail?

Offline crowessslain

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Re: Need help understanding and explanations needed.
« Reply #10 on: November 04, 2005, 05:22:24 PM »
I have a question about a knee problem i'm having...

About 2 years ago i remember i slipped on some ice and the feeling was as if the top part of my knee went one way and the bottom part of my knee went another and instantly snapped back. there was a realy loud crack. i got back up and i wasn't able to go up stairs and couldn't even handle walking up the slightest slopes on the ground for the next couple of days after that if i moved my knee a little bit i could feel my knee unhinge and pop back. so over the last couple years even just walking normally i feel the same sensation of my knee poping in and out of place as like what happend when i slipped on the ice and it's just as painful. Now the other day just walking with my friends something gave out and i collapsed and there was an even louder crack than before and everyone around me heard it. I wasn't able to walk but inches at a time. Right now i'm in an imobilizer and on cruches and have been pretty much since it happened but i need to know what's going on with my knee.

One really weird thing though if you can imagine a teeter totter, i can take 2 fingers and place them on either side of my kneecap and it wiggles EXTREMELY easy like its on a rea loose wire.
and i can move my knee cap about1 1/2 inch either way, and in a circular motion is it suppoed to do that normally?

Marisa















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