To scooter or not to scooter?

[SqshPlr8]

Just saw the doctor.  He said that if I were still a complete mess, he would have recommended bailing and getting surgery.  However, since my symptoms have improved and I can swim (a bit) -- but I am still having some major difficulties -- he recommended the cortisone shot as a way to calm things down and get rid of the impingement, therefore allowing me to recover more fully.  

I asked whether a new image(s) would be helpful before getting the cortisone shot.  On the basis of his examination and my description of the symptoms, he said that 1) it seems doubtful that anything has changed since the last image, 2) even if things had changed (e.g. slight damage/irritation of the medial condyle) it most likely would not change the recommended immediate course of treatment, and 3) if I were to get surgery -- which I have no appetite for at the moment -- I would get a "battery" of tests prior to the procedure anyway.  (I felt this was a pretty convincing argument and was thinking along similar lines prior to the appointment).

He said it seemed reasonable to take time off work (1 - 2 weeks) after the cortisone shot -- not that I would be a bed-bound; rather, I would be more freely able to dictate my movement and comfort.  Plus, I could (lightly) swim more.  

Finally, he said that if I wasn't substantially better by, say, the New Year, he would recommend the scope.  

Even if I am still really symptomatic in January, I am honestly not sure if I would want go through with the surgery.  But I will cross that bridge when I get to it, I suppose.
 
Overall, I felt satisfied with the appointment.  The doctor satisfactorily addressed my concerns.  At this moment, then, I do not feel that it's necessary to solicit more opinions.   I will wait until January or thereabouts to consider that type of stuff.  For now, I will (most likely) see how the shot goes and conscientiously and carefully move forward.  

[SqshPlr8]

Hey smilie,

Are you going to give the Voltaren a try? Or seek another opinion? Or all of the above?

Hope you feel better. 

[smillie]

Sqsh--sounds like you have a plan for now. That's a good thing.

I'm definitely going to try the Voltaren gel. I had good results from the oral version, but the depression that it brought on was unacceptable. My OS said that the gel should give me the relief without the depression, so I'm hopeful. It was a bit expensive, but if I can function with it, then it may be worth it. I'm hoping that I won't over-do and cause harm as a result, though.

[knee always hurts]

That account I posted wasn't even the worst of it. In the early morning, I had awoken in the middle of the night, and noticed that the pain level was higher than it had been. As I was anxiously ruminating over the possibility of a sleepless night, I suddenly started to feel this strange crawling feeling on my foot. Within a few seconds, my heart was racing out of my chest, the blood felt like it was draining out of my extremities, I had trouble catching my breath, and these feelings of unreality, like I was no longer connected to my body, started to overcome me. I literally thought I was dying. I got out of bed and went to lie down on the sofa, and I started shaking uncontrollably. Just before I was to keel over and die, I said to myself, "Hey wait a second, isn't this what is known as a panic attack?" So I looked up the symptoms on the computer, and sure enough, it described it to perfection. Maybe it's time to check into the psychiatric hospital. That was the first time that has ever happened to me, and hopefully the last.

http://www.artchive.com/artchive/M/munch/scream.jpg.html

The doctor said that it can't be "bone on bone" since the joint space looks fine. He suggested that it was probably something other than cartilage, but I'm well aware that only an MRI, or ideally an arthroscope, can detect chondral lesions. They would be smaller lesions, perhaps only on the patella or femoral condyle, though. But could it be that painful? I've read plenty of accounts on these forums of people managing chondromalacia for years, and while it is uncomfortable for them, and certainly limits their activities in many cases, it doesn't sound like what happened to me. But without an MRI, which has been refused to me several times, I'm going to continue to be left wondering. When the insurance application is accepted, I'm going to try to get an appointment with that doctor in Boston. Hopefully it will be soon, or I won't be able to afford my hospital bill!

Are you feeling that spiritual feeling in your bones too, SP? Like an awakening, or epiphany? I remember the time the lame man was lifted before the Lord, and the Lord healed him. Who needs all of this icky science when you've got the good Lord to heal you up? Must have been good times those! Maybe this new Congress we've got here in America can put some funding toward that good ol' fashioned healing! Because heaven knows that science ain't comin' through for me right now. Vaudville-reenacting seems to have about as much promise as the medical establishment toward helping to heal my knees at this point.

All of the research I've done seems to have gotten me nowhere as well. I think I just need to chill out. That panic attack is a wake up call. I found a site describing "health anxiety" (I think that this is a similar thing to hypochondria.), and it sounds quite similar to what I'm experiencing. I've always been a little jittery, I think, but the last few months has me facing a generalized anxiety disorder in addition to the pain. I think I just need to calm down, stop thinking about the future as hard as it might be, take each day as it comes, and follow the basic principle of the "envelope of function", trying to minimize the damage and maximize the chance of recovery. Eventually I'll get an MRI, and hopefully a diagnosis.

I think at this point, a cortisone shot is worth a try, especially considering that you know that it's the plica. One should do the trick, though, and if it doesn't I don't think I'd try it again. You don't want to carpet bomb your poor joint in addition to all it's already been through.

Funny thing, smillie, the ER doctor didn't mention the quad thing, either. But I still feel like I'm getting the runaround. Maybe it's not science that is the problem, but the physics of this ridiculous PF joint. I think we need to replace the phrase "Achilles heel" with "patellofemoral joint". Vulnerable though it may be, at least the Achilles heals in 3 months, even if fully ruptured. The PF joint on the other hand? Sadly, we know all too well!

[knee always hurts]

I've tried getting off the crutches a couple of times in the last week, and it's a no go. The pain and burning starts almost immediately when I try to walk. Walking slowly doesn't help. Apparently I'm going to be on crutches until I get treatment for whatever is wrong, which could take months! I can't even make an appointment, because I still don't have insurance. And I've read it could take up to a month for it to be approved.

The last few days, I've really not slept well at all. I'm lying awake for hours, and sleeping only intermittently. I'm exhausted, emotionally drained, and in constant pain. It's hard to imagine a worse turn of events than this. How is this possible? My joint was completely pristine 6 months ago, as far as I know, and I never sustained any serious trauma that should cause this! This is worse than what I was suffering over the summer, because at least that would calm down when I used crutches. This is hopeless. The vicodin really doesn't help me to sleep, the naproxen caused stomach or intestinal problems, so I stopped that, and the mainstay for so many on here, ice, is verboten because of the strange circulatory problems that it caused. Speaking of which, my foot really doesn't like being on crutches, because when it is just hanging there, the blood seems to pool, and I get problems with tingling, burning, and numbness. My foot turns a reddish hue which only subsides when I put my feet up. I was really hoping that this would be a temporary problem, but after more than 4 months, it seems like a permanent condition now.

Life is really strange. Take a perfectly healthy 26 year old, injure the ligaments in his foot a little, and then set him loose for the next few months without any information on how to manage the problem, and look what happens. One problem led to the next, which led to the next, and then the next. This is almost incomprehensible, but I'm not expecting to ever be "normal" again. I guess any expectation of anything happening is a delusional imposition of the mind, anyway. There's a lot more ways for things to go wrong than to go right, if I'm allowed to call what happens "right" or "wrong". We desperately want things to go "right", though, and we see a lot of people around us for whom things do seem to be going "right". Of course, sooner or later, things don't go right for them, either. Such things happen, and it's a test of our fortitude when they do. And that's a test that I've admittedly failed. Quite miserably really. I've honestly never known anyone personally who has gone through anything remotely like this. Is this response a normal one, or am I just nuts? I don't really know. Some people go to the museum with their Sponge Bob pajamas on and end up having a good day anyway. We were all born naked, bereft of cloths, and thoughts, and ideologies, and of the cold truths of the world. And then we acquire them. Sometimes they have a Sponge Bob print on them. That's just as random and absurd as anything else.

No, I'll probably never be "normal" again. Or maybe I will. And then there will be something else, another obstacle. I used to like to take a walk every now and then. Just in the woods behind the house. Such a simple pleasure. Who would have thought that it might be forever denied to me?

I'm just biding my time until I can see the doctor. There isn't much to do in the interim.

[knee always hurts]

Sorry about that, but this week has just been insane. Still, I'm not the only person in the world who is in agony. I just want a diagnosis!

What is the best course of action if this pain doesn't decrease much over the next few days? Go back to the ER, or just wait? I don't know. I'm just afraid of my leg wasting away. The sooner I get treatment the better, but I don't have any other option right now.

[SqshPlr8]

You have been through the ringer, man.  I am sorry to hear about your latest descent. 

The insurance issue definitely throws a wrench into the equation, but if you are in too much pain to handle then go back to the ER.  Is there any way to expedite the application process? Does Massachusetts allow sub-30 year-olds to go on their parents plan?

In terms of anxiety and panic, I completely understand.  In fact, I started seeing a psychologist to deal with the pain and my handling of it.  I can't say it has helped the pain itself, but it has definitely mitigated my suffering.  I realize a psychologist or health professional may not be in the deck of cards at this time, but perhaps a pain/anxiety support group?  I'm not trying to minimize your physical condition -- quite the opposite -- but talking about it with someone may ease your suffering as it has mine. 

Hope things start to get better soon.

[knee always hurts]

I know that this is a knee forum, but I think the mental anguish comes along with the territory. I'm sure that some handle this better than others, but at least for me, recently the mental suffering has been worse than the pain itself. I've noticed that most folks don't seem to mention how well they're handling the pain psychologically, preferring to talk only about the procedures that might help to cure the condition. But I think that mental anguish inherent in chronic pain sufferers should be brought out of the shadows. And what better a place to do that than on a forum where other people might actually have some understanding of what you're going through. It's been just an incredibly lonely experience going through this. Nobody in my family can relate to what I'm suffering. Many days I don't even walk outside. I used to walk 5, 6, or 7 miles a day through the woods like it was nothing. Now I feel totally detached from nature as well. Often I feel this pressure in my head, and I start to feel detached from my body. Maybe I'm trying to separate myself from the suffering.

A psychologist might be in the offing if this doesn't start to improve within the next few weeks. Unfortunately, the cutoff in Massachusetts to be on parent's insurance is age 26. Just my luck, again. An anxiety support group might be a good idea. I'll have to look into that. The things I used to do to manage anxiety are no longer effective, and I feel like I have no control over my thoughts. One moment I feel fine, the next my head is just spinning and I'm overcome with anguish or anxiety. I've had goods days and bad in my life, but never anything like this.

Pain and disability is difficult to deal with in it's own right. But when your mind no longer responds to the circumstances in a rational way, you just start to feel hopeless. Things will probably get better at some point, but it's hard to see light at the end of the tunnel from where I now stand (Well, sit).

[SqshPlr8]

Going in for the shot tomorrow, then taking two weeks off work. 

The plan is to take it real easy this weekend -- hopefully there won't be too much of a flare -- then slowly resume my currently non-irritating activities.  Even if something feels "good," but is out of my "pre-shot envelope of function," within this 2 - 4 week window (the approximate time this derivative of cortisone remains in the synovial fluid), I am going to try my best to avoid it.  Hopefully this will slim the plica down and stop the cycle of irritation, inflammation, irritation, etc, which will allow me to start building my joint, and then my muscles, back up again.

Of course, one of these two weeks will be spent with family for Thanksgiving...so I can't really call it a vacation... Just kidding! 

[knee always hurts]

This is probably your best hope to beat this without surgery. It sounds like you've got everything prepared on your end. Good luck!

[Snowy]

and I get problems with tingling, burning, and numbness

Have you considered CRPS as a possible cause? Notoriously hard to diagnose, but one of the few things that could explain all your current symptoms and the suddenness of their onset.

The anxiety disorder is no minor thing, either. My partner has suffered from severe panic disorder for more than 15 years (to the point where three doctors certified that she would never be able to hold a full-time job or live a normal life) and now keeps it completely controlled with very minimal medication. If you find yourself suffering with further panic attacks, let me know and I can get J to pass on some tips for dealing with it.

[knee always hurts]

Yeah, if you read in the Sore Knees, No Diagnosis thread I said I thought I had that a couple of months ago (The CRPS, that). But that is probably just crazy speculation on my part. It fits the diagnosis of some sort of venous insufficiency really well. The abnormal blood flow causes a change in sensation. It actually does fit the CRPS diagnosis to some extent, but wouldn't it have been a lot more painful to begin with? The foot thing really isn't "painful" at all, just quite uncomfortable. And could icing trigger it?

Now, if I do have CRPS, I think I'll probably permanently have panic disorder. If I have another panic attack, I'll post about it.

[SqshPlr8]

If neurogennic inflammation is the issue, then maybe try capsaicin? For that matter, I wonder if anyone has tried intraarticular botox injections...

[knee always hurts]

Until I had considered venous insufficiency as a possibility, I had thought maybe it was CRPS. There are a few things indicative of that:

1. Skin color changes
2. Sensations are similar to CRPS, but very mild rather than severe
3. The thing that really concerned me was that the condition started only on the left side, and then mirrored on the right after a few weeks. It sounded like classic CRPS to me.

On the other hand, venous insufficiency makes sense because:

1. The skin color changes are primarily when standing up. When I prop my feet up, the color quickly goes back to normal. It is at the worst when crutching, which make sense since the leg is just freely floating there. When there is a malfunction of the valves in the veins, the muscle contractions can still help to get the blood moving. With crutches, there aren't any muscle contractions, and thus a greater insufficiency.
2. The sensations could be caused by peripheral neuropathy, which can be a secondary condition to problems with blood flow in the feet.
3. The condition got a lot better when I was able to walk more a couple of months ago, and the PN was almost gone. It has returned with a vengeance now that I am back on crutches.

Of course, this still doesn't explain why the condition would mirror to the other leg. But maybe the veins are interconnected in some way. I can only speculate, I suppose.

The problem is that the pain along with the tingling was the instigating factor in setting off that panic attack last Tuesday morning. And though I haven't had another, when I wake up with the uncomfortable tingling sensations, I can't fall back asleep because of the anxiety. I know a lot of people with panic disorder avoid the situations that they think set off their attacks. But I can't avoid sleeping, and I can't avoid my knee pain or the neuropathy. So I only slept maybe 2 hours at most last night.

Irrespective of the cause of the foot issues, the current knee pain I'm experiencing could be CRPS. I don't have any other explanation as to why it would suddenly worsen to that extent. Lest anyone think I am in constant agony, the pain has settled down a good bit, but of course I am not walking at all, which isn't tenable in the long term.

I'm thinking that a trip to a vascular doctor is going to be on the agenda as well when I finally get my insurance approved. From what I've read, if it is venous insufficiency, the only treatments are compression socks (No more wearing shorts in the summer, then), or some procedure to close down the offending veins. I just think it's strange that I can't find a single case of someone with a similar situation. Why would icing cause this? I had read, and was aware that over-icing could cause frostbite in an extreme case, but not this.

I think it makes sense to at least get an MRI (And maybe ultrasound on the veins) before considering CRPS. But if the MRI comes back clean, it would be a little frightening to even contemplate surgery, since it's my understanding that it could dramatically worsen the CRPS.

Here I go again throwing myself into a tizzy. But without access to a doctor, what can I do?

[SqshPlr8]

The cortisone seems to have helped, overall.  Definitely reduced swelling.  Doctor says that it will be two weeks after the shot to the see the maximal effects.

Have been relaxing and going to the pool, as I have taken a couple weeks off work.  Though last night I went to a friend's birthday party and I probably stood around too much.  So my good knee is bothering me today, which is frustrating as I kind of see this as my last "conservative" effort. 

But we'll see.  Day-by-day.  Breathe. Stick to the plan and hopefully salvage the remaining twelve days of "vacation."

Unfortunately, I got a call this morning that my dad fell down the stairs and punctured his lung, but he'll be fine.  So he's in the hospital for the night.  Ugh. 

This medical stuff never gets old...