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Author Topic: 6 weeks, many doctor visits, don't know what else to do, suggestions?  (Read 1452 times)

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Offline anaid

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6 weeks ago my daughter injured her knee at work, she was twisting to pick something up and had her foot planted when she felt and heard something pop.  Took her to the clinic and they gave her a brace and ordered an MRI, referred her to an OS.  OS did his exam - is it normal for them to not ask how far one can comfortably move the knee?  He just told her to relax her leg and grabbed her ankle and moved her foot clear back to her rear, ignoring the grimace of pain and sucked in breath. He told her she needed to start walking on the knee.

When we returned to the OS for the results of the MRI (Arthoscope - they injected the dye in her knee) showed no damage to soft tissue, lots of fluid (this was 3 weeks after the injury), knee cap displaced due to fluids in knee, suspected micro fractures and bruising to the bone.   We don't know why there would be bruising to the bone since there was no impact. 

OS asked if she was doing physical therapy, ordered physical therapy for her and told her she was "not doing herself any favors by not walking on the knee".  When we asked at what point the pain went from working through it to maybe I'm doing some damage he just turned away from us to look at the films and said her pain was a mystery because there was no damage that would indicate the pain she said she was feeling.

We took her to another doctor (on our own - insurance wouldn't approve a change of doctor) for a second opinion and he said that since the MRI didn't show any damage the only other diagnosing tool would be to go in and scope the knee but he wouldn't do that because the injury was so recent and there was still swelling in the knee he didn't want to do surgery to discover that the knee was simply irritated because of the swelling.  He recommended that she finish her physical therapy and see how it felt in another month or six weeks. 

She returned to the original OS (change of Dr. still not approved), he still has not, at any of her visits, asked her where she is experiencing pain, berated her for being on the crutch (she has graduated to just one), belittled her about whether she still has a job - actually spent more time on that than on her condition, told her to finish her physical therapy he would see her in two weeks at which time he would give her a full release. 

When we asked what is wrong with the knee he said it was sprained.  When asked why he didn't tell us that before he said he thought he had but it was in the report anyway -- which we were never sent a copy of so what good does that do us?  We asked why she was still experiencing so much pain and he said because her knee is sprained.  No mention of specifics on the sprain, what area is involved or to what degree.

We've called the diagnostic center to ask for a second reading of the MRI (haven't heard back), the second opinion doctor seemed inclined to go with what the MRI said.  She is experiencing pain just above the knee on the inside of the leg - she doesn't even want anything to touch it, the back of the knee is also tender, the chiropractor looked at it and said there's lateral movement of the kneecap.  Weight bearing is extremely painful and moving the knee creates a very painful popping (her description).  Now that the physical therapy is working on weight bearing (they started with range of motion, which has improved but full bend or weight bearing bend still isn't possible) she gets stabbing pains on that inside portion of the knee, with the increased tension during physical therapy the pain has started moving across the knee.  The physical therapist has said what he sees looks more like tendon damage but nobody is listening to him.

We know we'll have to fight the system to find a new doctor that has some compassion and ability to communicate/care about the patient, but we need some help.  If we don't know what questions to ask it's hard to ask the right question.  Obviously with doctor wonderful a general question won't work so if someone could give us some advice on exactly what to ask to start nailing down some answers that would guide us in a given direction we'd appreciate it.  

Sorry to write a whole chapter - tried to narrow it down to what I thought would give enough background!


Offline Nettan

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Just a question..was the Mri done when she still had lots of swelling ?
Surgery 6 times left knee torn meniscus, RSDS,chondromalacia, nervdamage cause constant nervpain,chronic inflamm.
Spinaldamage wheeler 100%.
Right knee damaged aug-06, use brace surgery 4/9-07.LCL tear.

Offline shortyclairebear

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hi there!
im so sorry to hear that your daughter has received such terrible treatment from the doctor.
i really do think some of them need to be taught a bedside manner.
his response to your questions sounds very vague and i can understand how frustrated you both must be.
is it possible to get more opinions??
i had a lot of soft tissue damage to my knee that was not showning up in the MRI that i had,the only thing that did show the level of damage inside my knee was having an anthroscepy done which was a year after my initial accident (and after 2 different lots of physio and several opinions later.)
i had to have x 3 different procedures done on my knee at the same time in late january of this year to correct the problems i had,i'm on the slow road to recovery now but feel quite mad that i was fobbed off for so long and wonder if the damage to my knee was made worse because i was misdiagnosed for so long and treated by physios for conditions i did not have.
i strongly recommend to get another opinion or another still if needed,and at least to see someone who is prepared to listen to you both and take this seriously rather then dismiss what you are saying.
good luck with it and keep me posted how you get on!!
claire. :)
i had a motorcycle accident-landed on right knee!(mar 05)
...arthroscopy - 4th feb 06.
...VMO Advancement,LR+JMedial reefing - 24th jan 07.
...28 feb 07 i fell down 14 stairs.....more pain and stress!
...now at PT working on ROM and strenghening

Offline anaid

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At the time the MRI was done it appeared that the swelling was down, but for the most part it seems like the swelling is more inside the knee - it's has never looked grossly distorted.  She had been off the knee for two to three weeks by the time the MRI was done. 

Seems like there should be some questions we can ask the doctor, or some standard questions he should be asking her that we're not connecting on.

Offline Nettan

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Why not simply try to get them scope her knee to find out what's really wrong ?
Though if she has some sprain, like I have with my LCL that will take time to heal. My phys talked about 6 months to fully come backl.
Just ask what the OS think is wrong or if he's guessing the diagnos. No questions or statements from your side is wrong.
Surgery 6 times left knee torn meniscus, RSDS,chondromalacia, nervdamage cause constant nervpain,chronic inflamm.
Spinaldamage wheeler 100%.
Right knee damaged aug-06, use brace surgery 4/9-07.LCL tear.

Offline ataraktos

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Sorry I can't be more helpful w/ specifics but one thing, unfortunately, I've had a lot of experience with is, to put it politely, "lack" of bedside manner! If the first OS is being such a "lack" now, just think how "wonderful", to use your phrase, it will be to have him for a surgeon!!

Things can go wrong with surgeries - he had nothing at all to do with her injury and he isn't being very helpful ... if he's belittling your daughter now, trust me, you *do not* want to have any scope, or anything else, done by him ... take your crutches and hop, if need be, to someone else!

I would've fared much better had I listened to all the warning signs with my OS (who had the nursing staff almost in tears, dealing with his rage, immediately before my operation.)  I made the mistake of thinking there's a difference between competence/surgical skill and bedside manner. And to some very small degree, there is. And you obviously don't want the nicest OS in the world who doesn't know what he's doing. I went on to make the same stupid mistake with a "lacking" PT outfit - let me tell you, a great combination!

But if this guy is not being helpful now, he will not get any better - he's telling you what kind of DR and person he is - listen to him!!!


Offline Annika

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Dear Anaid,

No one of us can tell you what its wrong with your daughters knee, an MRI can show quite a lot of things but doesn't always tell the whole story. A scope is the only way for a doctor to be totally sure and that is I think why many OS are reluctant to give a diagnosis upfront. Now, it does sound like your OS has a lack of manners and that may hide a lack of competence - bluster to hide- but it may also be he is just a terrible communicator. A second and a third opinion - even if you have to pay for it (a single appointment can sometimes be affordable) is not a bad thing at all - and would set your mind at better rest. My OS did not like to talk alot - but I 'listened' to his hands when they touched my knee and his reputations among fellow skiers is superb. Maybe someone you know have had knee probelms and can recommend someone to see if only for second opinion. By the way most but not all surgeons insist on waiting for the swelling to go down before a scope/operation as swelling distorts and sometimes hide other issues.

The insistance that your daughter give up the crutches and work hard at PT may seem heartless but in many cases OS are quite ruthless about this because most people who have injured themselves tend to 'baby' their injured part and in the case of a joint it is essential that it keeps on maoving. Now in your case it may well be that the injury is too severe and painful. I was shocked when after breaking my ACL my doctor insisted that I immediately got up and started walking, he banned crutches and allowed me a brace for just a few days. I wanted to curl up in a corner and die! His threats of daily injections to combat bloodclots had me up and about since I hated the thought of daily injections more then the fear of further damage.

Good luck, Annika
ACL bust 3/3/07 France skiing
ACLr 17/4/07 France
UK & Sweden for May & June 07 rehabbing
Full extension at around 3 1/2 months
First heel to bum at just under 5 months















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