Depressed, conflicted and exhausted

[HyperZen]

Today sucked. I was supposed to go in to PT just to get measured today, as my PT clinic's manager is a stickler that since I had my MUA I don't "regress." I measured 120 on Thursday (two days post MUA) and worked hard on my own Friday and felt very bendy and strong. Saturday I started to feel tired and sore but continued to push on. Yesterday my knee blew up like a balloon. Most of the day it was so swollen that it was hard to walk. Nonetheless, I did my exercises and 10 minutes very slowly on the bike.

Today, I was feeling stiff, so I called the clinic before I went in and talked to my PT. I told her I was feeling stiff and that I had a lot of swelling yesterday. She said I might have overdone it over the weekend and that maybe we needed to back off a little until my knee settles down. She decided I should come in to get measured and so she could do some soft tissue work and reassess.

I got there and took quite a while to warm up before I got measured. 110. We did some more stretching and a few other exercises and I measured again. 110 on my own, 115 with a push from my PT. She set me up on ice and we started to talk about when I should come back.

Then the manager asked what my number was. We told her 110 on my own and 115 passively. She said, "you can't leave. You are staying here until you get to 120. Get off the ice and get back on the bike."

I started to cry from frustration and because I knew the manager would push on me despite the pain and swelling. I honestly think she tried to do a manipulation on me in therapy early in my recovery, right after surgery!

And my poor PT. She's new, and I've had issues with her because of that, but she and I had a good talk a while ago and have worked well together since. I'm one of her first patients and her first MUA. She had no idea. Both of us got completely blindsided by the manager's order.

By that time, I had been there an hour and my meds, which I had taken early that morning because I was expecting just to get measured and go in to work, had worn off. I couldn't stop crying. It was SO embarrassing and I felt humiliated in addition to sore and frustrated.

I got to take more meds and was there another hour. After pushing, pulling and crying I got to 118. She let me go. But I have to go back tomorrow, and I am SO conflicted. She keeps telling me that the "scar tissue" which I know from Jo is not really scar tissue but adhesions caused by tissues sticking together from being exposed to air in surgery, will come back if I don't maintain the same ROM or make improvements every single day...but I have heard on here that it is rare that that happens. AND, I feel as though the tissue pain and the swelling from the MUA (which was less than a week ago) impact my ROM as well...

Anyway, I am resigned to going in and pushing through it tomorrow and how ever many more days I have to push through it to get to the damn number. (Okay, I want the number, but I want more than that, and I am really down right now.)

Mostly I am angry by how the manager handled it, and I aim to tell her so tomorrow. She SHOULD have trained my PT and talked to her before I ever came in the door about what the expectations and processes are when someone has had an MUA. Instead, I got to be a living example and lesson in front of a room FULL of other patients and PTs at a time when I am feeling lousy in lots of ways. It was humiliating for us both, and since I am the one paying to go there, I'm going to say so.

Again, it comes back to expectation management. No one told me what the expectations are and I am now conflicted and feel like I have to work on it constantly for fear of regressing, even when I am in pain and exhausted...and even when I am told not to overdo and to ice a lot...When do I rest? Does the knee get time to settle down??

Thanks for listening everyone. Please send some healing energy for my poor knee, because it's pretty much in for it....I only pray that 120 starts to come easier soon.

 

[KarenD]

Jill,

You are so right--the manager should have been civil. Remember they are vendors and you can fire them--you can get another PT anytime--let the manager know that.

My PT at the hospital had told me that I could not overdo the therapy, but my OS said that I could. I believe him.

Hang in there--TKR is hard enough without enduring a bad PT experience.

Karen

 

[Texas]

Jill NO NO NO you shouldn't have to cry tell that manager is she crazy you shouldn't have to be in that kind of pain 110 is petty good whats her problem.......when if you go back please tell her it was to much becasue thats true you push so hard that your set back for a few days dont do it......please let your OS know what happens that isnt right............shouldn't be in that kind of pain..........now we will worry the next time you go......i know you have to push but cry no im sorry..............keep us posted and ill keep you in my prayer sweetie im sorry just ice and relax.............

 

[brs0660]

Life: Depressed, conflicted and exhausted

What a twitt that manager is. ROM is a number it is not the all ending requirement. I get so sick of PT's and managers going for the number. Wonder if their bonuses depend on how many people reach THEIR numbers. Also anyone who embarasses me or makes me cry in front of a room full of people needs to explain face to face. And to make you do PT when you had not :cool:had your meds is dispicable.

I agree there are too many PT options open for folks.. including you! I would make an appt withe the manager and be sure to tell her how she embarassed you. If direct confrontation is not your style write a letter...YOU are responsible for your well being and happiness.

110 is GREAT

 

[Judles]

Gee, sooo sorry, Jill! It's one thing to be firm/ quite another to upset a patient like the mamager abused you! Of coursen you would be emotional! But the manager should have been a lot more understanding! For one week out, you sound like you're really doing well! Stop, pat yourself on the back, and know that it osn't you. It's THEM!!!!! Hang in there!!!! (0)

 

[Judles]

Gee, sooo sorry, Jill! It's one thing to be firm,quite another to upset a patient like the manager abused you! Of course you would be emotional! But the manager should have been a lot more understanding! For one week out, you sound like you're really doing well! Stop, pat yourself on the back, and know that it osn't you. It's THEM!!!!! Hang in there!!!! (0)

 

[beth1954]

As most people here know, I had a bad time with my first PT experience. The girl was an intern, and I was under the impression that she was a Physical Therapist that actually graduated with that degree!! :D

One day she was working on my ROM and I guess lost her mind for a second. She pushed my leg down so hard, that my foot was practically touching my butt! I screamed out in pain and cried like a baby! The doctor came over and kind of "covered up" for her. The whole thing angered me so bad! I went the "letter writing" way because I can express myself better. The next time I went in the first thing he did was thank me. He said he knows it is hard to write a letter like that, and he could tell it was carefully thought out. He thought that it was pushed so hard that my scar tissue might have torn.

The intern apologized too, and I got a different PT after that. She is very gentle and does not push me. I go as far as I can with the flexion (which is about 112 on a good day) and that's all.

It makes me feel so bad to hear of your experience.

My home PT told me once that "You are the boss of you." She said anytime something is so uncomfortable that it feel its intolerable, tell them to stop. When I first did that they looked at me like I was nuts.

I know it's kind of a hassle to change facilities now, but you may have to.

 

[skigirl]

Jill, I agree with you that the manager handled the situation very badly--and, I do hope that you write a letter as well as talk with her. She owes you a PUBLIC apology in front of the same patients!!!

My PT (who has a PhD in physical therapy) is really good and is a very gentle man. However, he is helping a friend who just had her second MUA and she is having therapy five times a week---Ben feels very strongly that the therapy must be agressive after a MUA to avoid the return of stiffness. Now, my friend does not have a knee that looks like a balloon--so I wonder about what kind of therapy your pt is using.

So, for your own sake---after all, we are our own best advocates, I would spend a day with my knee on three pillows---boring as hell, yes, I know. I would ice, ice, ice. I would take an anti inflammatory and I would even consider taking something like Lasix, which removes the water from your tissues. The latter is a script, so you would have to call your doc. In other words, I would be very agressive with this swelling.

Then, when the swelling is better--and it will be better after a day in bed!!--you can go to pt and do the agressive pt that you need after your MUA. A person who humiliates her patients and does not explain how to solve the problem--i.e. the swelling issue---should consider another field than health care.

 

[marquesa]

Hi Jill, it sounds like "Nurse Cratchit" has moved in to the physical therapy field.

I am so sorry she treated you that way. Some people drag all their "stuff" with them wherever they go.

A person recovering from major surgery, especially this one with it's accompanying muscle pain and trauma, should only come into contact with gentle, caring, and supportive people. Good results do not have to include intimidation and rudeness.
I am sure many other people will benefit when you bring her conduct to the attention of the person supervising her. Written letters are the best, I agree, because you can say it exactly how you want it said, without emotion.

This person needs "a talking to" , as my mum would say.

Take care of yourself!
Hugs, Marquesa

 

[betsy13]

I'd complain loud and long!
My PT told me the max I'll probably get is just over 115 because I have fat calves (band and miltary marching did me in!). So for me anything over 110 is a plus. We did get it to 120 with him pushing but I couldn't hold it there.

 

[HyperZen]

Thanks everyone. I had an easier time today. The manager was not there, but I told my therapist that I was very angry yesterday. I will follow-up with a letter to the manager.

Kelly - I appreciate the information about aggressive PT being needed after an MUA. I was somewhat resistant to believing that (well duh, it HURTS) but mostly what I was resistant to was that I was informed nor involved in the discussion until we were way too far into the process.

Anyway, I went in today and put my head down and worked hard. It was very stiff and sore at first, but at least the swelling was not bad. And, I got to 116 on my own and 122 with some pushing and pulling from both my PT and I, but not nearly the drama of yesterday. So there is a light at the end of the tunnel...I just have to be willing to go through the pain, which is so hard to want to do...

Thanks everyone for being there!

 

[loggon]

Jill wow I would not still be there and I certainly would have sent a written complaint to the owner and the BBB.
The manager had no right to tell you to get back on the bike and you were not leaving until you got to 120. I would have walked out.

You pay the PT and you have the right to say what and how you want the PT.

No you do not have to have aggressive PT after MUA. Many folks on her did not and they have great ROM.

My first and my last PT had a PHD in Physical Therapy and neither agreed with the old way of aggressive PT. Many get hurt in aggressive PT.

Gosh I feel so sorry for you. But please don't think you have to take that. You will get to what you are going to get to and it does not have to be aggressive. My rom is great or as my doctor says "Your Rom is awesome".

I feel really angry at the manager for doing that to you and I do hope you will take proper action against her.

Rom is truly just a number as one of the folks on here said. As long as you have the rom to do what you want you are doing great.

 

[HyperZen]

I am writing my letter right now. I was planning to talk to her in person, but she wasn't there today and will not be in when I go back on Friday.

I still don't believe all the hype that if I have on bad/swollen day that I will LOSE EVERYTHING I EVER GAINED. I'm very tired of the scare tactics. I think a couple of the PTs at my clinic needs an empathy workshop! (I would love to know how they would handle it if they were in my shoes!!)

 

[cindy88fan]

Jill...I believe writing a letter will be better! Only for this reason: If you go in there upset, ready to rip her head off (which you should) you may be too upset and not say exactly how you feel. Write it out on paper, that way you can redo it if it's not exactly what you wanted to say. Then...I would hand it to her personally and have her read it in front of you and ask for an apology right then and there!This kind of treatment should have never happened to you! If nothing is done about it, she will continue to do the same thing to other patients. Aggressive PT is not good!!!!

 

[loggon]

You are so right Hyper. You will not lose, at least I don't think, but until the swelling goes down you might not have the rom.

I have not been able to exercise for about 2 months. I thought I had lost some rom but when it was recently measured, I had not.

Still say you don't need to have aggressive pt.
I don't like pain so no way will I have it. I have to start back to PT but because of my ITBand but will not have aggressive PT no need.

 

[skigirl]

I think the definition of "aggressive" therapy is a moving target.

Here is what my therapist and I agreed on: aggressive therapy is therapy every day, it is working together to increase my range of motion--which I wanted even more than he did. I had some pain in therapy---but I am talking about an uncomfortable minute or two while he helped to stretch my leg---but NOT so much pain that I felt like crying.

I think you need to be agressive with your swelling and make sure it does not hinder you in pt---I wore compression hose for a few weeks while not in pt, which did help. Also, If my knee got swollen, I was back on the bed for a day or so to bring it back down. I wanted to be aggressive to my knee--BUT NOT to hurt myself. Not to the point where I would feel so much pain that I could not stand it.

And I agree if someone had ORDERED me off the bike, I would have walked out too. Of course, you will not loose everything in one day; but when your body forms scar tissue---adhesions---and some folks have more than others, you need to keep bending that knee so that more scar tissue does not form.

Many folks have it easy and they waltz through therapy and tell everyone else that they don't need therapy-----but I have a friend, a fellow ski instructor, who forms scar tissue far more easily than I do. She has struggle with her knee---her rom last winter was 100--not adequate for our life as ski instructors.

This fall, she had a MUA and went to therapy every day for three weeks. She started with 120 and was delighted--but, she can feel her knee starting to tighen up again. I feel for her because I was lucky and did not have to worry about my ROM---but, I think they you will have to work the way you are working right now to prevent loosing some of the rom that you got from the MUA.

Each knee is different---each body is different. It is hard for us to give one another advice because we are not the same. What worked for me might not work for you. However, watching Lori I can see that she struggles more than I ever did with pt and the adhesions that are blocking her knee. That is one reason that we employ a professional---a physical therapist---to help us heal our knees. That person's profession is based on looking at your situation and then adapting exercises and stretching for you. I respect the profession---and the pts that I deal with now. But, I am not sure that I would have had a tkr if the pts that helped me with my ACL had been better therapists--and more anxious to listen to me.

I don't agree with the "attittude" of your clinic---dire threats are silly if the person is over five years old. I prefer an adult conversation with my pt---what is the best thing for my knee and what are my goals for my knee. then, how do we get there?

I think you need the pt right now, but I would consider looking around at other facilities in your area to see if you can find one which has an atmosphere of mutual respect between patients and therapists. I am sorry that I did not do that at once with my ACL. Kelly

 

[HyperZen]

Thanks again everyone! Kelly, I agree with your definition of aggressive - working on it every day in a very focused manner. My clinic's version of aggressive I do not agree with, and I am in the process of looking for another clinic.

I am being told I am one of those who develops adhesions/scar tissue quickly, so I am very dedicated to working every day to prevent that from happening. But I do have my limits. They want me to push myself "through" the pain and swelling to force the ROM while I am there, and my protests that that will lead to further swelling and then a decrease in ROM are not heard. Time to move on.

An excerpt from my letter to the manager:
Being told in front of a room full of other patients and therapists that I was not “allowed” to leave and not being involved in the discussion about why or what needed to happen next was insulting and humiliating. My tears were out of anger and frustration, not pain. I strongly feel as though that conversation should have been had in private, not in the middle of the room, while I was on ice with little pain medication in my system, believing I was on my way to work.
This is my recovery. You all see hundreds of “knees” a year. I have only two that belong to me, and I deserve to be involved in and communicated with about my recovery so that at least I understand what and why things are being asked of me...even if I don’t always comply the way you all believe I should. This is not an easy process, and to be treated like a child in front of others does not help. For the benefit of your other patients, I ask that you use a little empathy, respect and consideration in the way you choose to communicate the next time. We all deserve to have our dignity preserved, especially during recovery when we are feeling fragile and vulnerable.

 

[skigirl]

jill, that is a really good letter---not too angry and not whiny at all!!! That is a good tone to strike and you will get results, I am sure of it. Kelly

 

[One NZer]

Another bullying PT !

Writing the letter is the best thing to do, then everyone has a record. Make a copy and forward it to the owner of the facility as well and write a note to that effect in the letter i.e. "Copy forwarded to .... ".
This will put the PT manager on notice that everyone has been made aware of her bad attitude.

I'm pleased to read you are looking for another PT facility. Good Luck, I'm sure you will find a better one.

Work as hard as you have been, and long may your ROM stay large ! :thmb:

 

[Jamie]

Jill, I can only echo what the others here have said. This behavior by a physical therapy "professional" is disgraceful. You cannot "work through" swelling. The swelling must be under control before you are going to make much progress. That is only done with rest, elevation, ice and anti-inflammant medications.

An interesting thing about adhesions too....some people are more prone to them than others. But....some people who get them at a particular time do not necessarily get them EVERY time. No one can really say when or if it is going to happen. And that includes these therapists of yours who are practicing medicine without a medical license!

Your best bet is to continue with your letter and then promptly enroll yourself at another facility. Remember that in any profession, there are always those who passed the training, but were in the bottom 1/3 of their class. I believe you may have found a whole nest of them.