PKR My Drama Queen Patellofemoral Knee

[NavyGunns]

@kayow11,

Speaking from my own opinion, the advice you were given regarding legal action is probably spot on. While I full agree it’s important to hold doctors who are negligent and irresponsible accountable for the outcomes of their actions, unless there is evidence and history of similar actions, proving negligence will be hard. Sometimes we just have to face the facts that things don’t always turn out the way we would like. God works in ways we don’t always understand or agree with and gives us challenges we don’t want or feel we need. In time, hopefully we learn from them.

But it is good to know you have the option in the event you get insight to similar cases and yours does not resolve the way you want.

 

[mlwreader]

@Jockette I recently fired a doctor - since I am new to town I needed a new primary care doc. On medicare, there is an annual wellness visit that is completely covered. Basically they take your vitals, ask if you have any concerns or issues, and counsel you as to your immunizations and other preventive tests that are due to be conducted. So I went to this recommended female internist and it was not a match made in heaven.

After seeing her three times, she still hadn't done, talked about or advised on any of the things on the medicare checklist. All she could talk about as she stared at her computer screen were the records my CA internist had sent her. After three visits I had had it. My allergies were screaming at me, and I had two other issues that she had not even addressed. So I told her about my dissatisfactions, and OMG did she not react well. She obviously was stuck in the doctor as God syndromes, and we agreed to a parting of the ways.

I did find another, younger, more proactive internist that took care of all my issues in ONE visit, and who I feel happy to have found. This second doctor had actually read my file and records prior to meeting with me - what a concept. All that first doctor wanted to do was make it about me, accusing me of being angry and wanting to prescribe me anti-anxiety medication. It was laughable. After listening to her go on and on and sputter and sputter I told her with all due respect, she seemed awfully defensive. She sent her office manager in to deal with me and that was the last time I saw her.

It is so hard to remember that these medical professionals are working for us. And that sometimes it is necessary to shop around, get second and third opinions, and things like that. Hang in there and know that we are with you 100%. No matter what!

 

[NavyGunns]

@mlwreader,

Good for you! Doctors are a service provider and we are their customers! As someone who is a quality professional, I find it amazing how many doctors fail to realize that concept! Just like any other business, if your customers are not satisfied with the product and customer care you provide, they will go elsewhere. Dissatisfied customers also tend to tell more people about their bad experience than do people who’ve had a good experience. One thing us patients tend to forget is that we can (and should) also voice our frustrations with the state or govt medical boards! The more they begin to hear similar complaints about a single doctor, the more likely they will be to do their own investigations.

It’s a blessing when we find a care giver who truly cares but can be a real curse when we don’t!

 

[sistersinhim]

Wow, what did he have to say?

He came over to my chair and pulled me back up under my arms. I never went back to him.

On all f/u visits he just sits on his rolling stool as I sit in the chair and he asks me to extend my leg and then bend it as far as I can without pain - and that’s it- no measuring no palpating

That's exactly what mine does! Function is more important to him than numbers!

I had expected a 2-3 month recovery, and he agreed that’s what I should have had.

He is being ridiculous! You are so much better off ditching him! I bet he had very little experience in partials and will never tell you so!

 

[phrog]

Hi, Jockette. It's been a long time since I've been on BS and tonight I read through the pages of your thread I haven't seen before. It seems you still have not made the progress you wanted to and understandably are quite frustrated. I am so sorry!! You said you did not want to involve a doctor who is not an orthopedist, and I understand why. That said, big breath here, because I respect your reasons, but I'd like to maybe suggest you reconsider and talk to an internist or family practice doctor. By doing that myself, I found out I have a pinched nerve in my lumbar region that is causing numbness and pain down the length of my TKR leg. Tired of my complaining, I am sure, my OS suggested in April that I see a neurologist. I went to my primary care doctor in search of that referral (I thought the OS was placating me and I wanted a referral from the internist who I trust very much) and she first did an MRI of my back which showed the pinched nerve. From there my primary sent me to an orthopedic spine specialist who will be doing an epidural steroid injection next week. For you, I wonder if a primary care doctor might just see the need to look beyond what has already been done for you. I'll let you know how my shot goes.

 

[Jockette]

Hi, @phrog , it’s always nice to hear from you!

Thank you for sharing your experience of thinking “outside the box” and looking in a different medical direction. I will have to think about that.

I hope the shot helps you.

 

[Jockette]

What is the purpose of TED hose post surgery?

How do they supposedly work?

By being tight on the leg do they force the swelling to another part of your body?

Thankfully I wore them less than 2 weeks and had my surgeon’s blessing to stop wearing them. Mine were not overly tight, and it was March, so being too hot was not an issue.

And some surgeons don’t require their patients to wear them at all.

So, what’s the scoop?

 

[NavyGunns]

@Jockette,

The explanation I got was that they help force fluid (which is the cause of swelling) up into the lymph system so that the body can better do the job of eliminating it. While healing, excess fluid is generated and when coupled with limited activity tends to accumulate in the lower extremities (physical activity such as walking, etc help to move the fluid into the lymph system as muscles are worked). At least that’s what my understanding is.

I found they helped a lot, especially when I had to fly 4 hrs at only 6-7 weeks post-op.

NG

 

[Xmasknee56]

Yes NG. I always wear the TED style socks for flying. And I wear the TED until 6 weeks post surgery. It’s a love hate relationship. I’m afraid of clots. My mother died young from an pulmonary embolism.
My ankles seem slimmer and no swelling there

My understanding is that they help with preventing clots but cause many broken toes, dislocated shoulders, broken marriages and spousal black eyes. Oops that was just once when I pushed too hard instead of pulling.

I don’t have the clotting factor my mother had and am just prescribed aspirin too.
Kathryn.

 

[Jockette]

So I’m spite of my knee’s issues, whatever they are, my bend really does continue to improve.

Yesterday at bowling I was sitting on one of the chairs that are higher up and are at a high counter. The chairs swivel and glide back and forth. My feet were on the foot rest attached to the counter and I realized how much my knee bent when I moved the chair closer to the counter. My operated knee was pretty much the same as the non operated one! I couldn’t even have done this a few months ago.

That’s the good news.

However, I can’t get anywhere near that same bend if I’m laying down.

I’ve been working on steps again and it’s not going great. I still need both a railing and a cane to go down steps foot over foot. And the step can’t be more than 6” high, even that height is pushing it. I have 2 steps from the house to the garage. I’ve been going down and then back up, 3 times, once a day. It’s been “ok”, but some pain the third time. Last night I did it 5 times. Bad idea. My knee is still upset this morning.

@Celle My husband and daughter tell me I should strengthen my knee. (no, neither has had a knee replacement) With an unknown something going on with my knee, should I be trying to strengthen it, which is somewhat painful, or just keep it comfortable?

I know Bonesmart says, if it hurts, don’t do it. Is that still true at 16 months post op?

 

[SusieShoes]

Strengthening the knee will help with your stability and ease on stairs. It will also happen naturally as you use the stairs. Your muscles will get stronger and better at holding and lifting your body. It shouldn’t really hurt your knee, though.

Are you considering revision?

I also have better bend in every posture except lying down. Not sure why that is. Might even be some kind of positional illusion. Lying in bed is not identical to standing is not identical to sitting. Anyway, that’s why I can’t get hung up on numbers. They’re all over the place!

 

[Jockette]

My surgeon always measured ROM with me laying down. Until I stayed in the chair the last 2 appointments. I guess if I was laying down it was easier for him to put my leg where HE wanted it.

In order to consider revision I would have to find a Dr to look past my perfect X-ray.

Some days I want that third opinion and other days I don’t. I’ve seen other members with multiple procedures within a somewhat close time period and some of them seem to really struggle to heal. Others do better because the second procedure corrected the problem the first one caused.

Such a quandary.

 

[mlwreader]

I’ve been working on steps again and it’s not going great. I still need both a railing and a cane to go down steps foot over foot. And the step can’t be more than 6” high, even that height is pushing it. I have 2 steps from the house to the garage. I’ve been going down and then back up, 3 times, once a day. It’s been “ok”, but some pain the third time. Last night I did it 5 times. Bad idea. My knee is still upset this morning.

@Jockette I have the same issues. I still cannot do steps comfortably and have to use the handrail to assist. Yesterday out walking I came upon a path I wanted to take, but I had to go up two steps with no handrail to reach it. I was able to do it, but my body english was extreme. Also, when walking and talking with a friend, I notice it is difficult for me to stay in a straight line. I guess I need all my concentration to stay straight. I'm not giving up though, and still believe that these issues will resolve over time. And I see my surgeon in Sept. and will ask him about it as well.

How wonderful for you that you have seen some recent improvement in your bend on that raised chair! That is wonderful news. Yay!!!!! Hooray!!!!!!

 

[NavyGunns]

@Jockette,

Something to keep in mind when it comes to pain when exercising. There is a difference between pain because your pushing your muscles to do more than what they are used to doing. That’s how you make them stronger, but pain because you’ve done something to cause injury is a no no. The first kind is tolerable and clears up with a day or so. The other doesn’t and gets worse with more activity. For example, if you weren’t used to doing sit-ups and decided you were going to start doing 20 a day, I guarantee your abs would hurt the next day! You might have to drop to only 10 a day for a few days, but the pain goes away and you eventually achieve 20 a day. However if you did something that caused a severe muscle tear, you would recognize the pain differently and continuing to exercise would only make it worse. So the question you need to ask yourself is “Is the pain going up and down steps tolerable such that over time it gets better or is it debilitating?”

Now that I’ve restarted my own exercise program, I’m constantly having to evaluate whether the pain I’m feeling in my knee is due to pushing my muscles and other soft tissues or is it something related to trying to make my knee do something it’s not yet ready for. I’m finding it’s somewhat of a trial and error approach, but when I hit and cross that critical line, my knee let’s me know immediately! Every day activities do help get you knee stronger but only to the limits you are placing on your activities. If I want to be able to walk 10 miles in hilly terrain but my daily activities are to only walk 2 miles on flat ground, I’ll never be able to achieve my true objective, at least not without suffering much discomfort afterwards.

I’m not suggesting you aren’t trying hard enough, only you can answer that question, no one else can!

Something you might also want to try is to keep a journal of activities you do each day and record how your knee tolerated the activity. This will help you gauge when and where to push things and where to back off. It will also help to show your OS at your next visit so he/she can have a clear picture of your activity level and limitations.

 

[Jockette]

I know what muscle pain from lack of use and trying to strengthen it feels like, and this is not it.

This more than usual discomfort is in the knee. It feels more out of joint than usual. It still feels bad 18 hours later in spite of being elevated all night.

My opinion is this is further indication that something is wrong but so far 2 doctors won’t look past my X-ray. I guess it time to try Dr. #3.

 

[Celle]

@Jockette - I think SusieShoes gave you the answer about strengthening. Just try to use your knee as normally as you can. I can't see how having stronger muscles will reduce the type of pain you have.

And yes, I do think it's time to find surgeon Number 3.

 

[NavyGunns]

@Jockette,

I completely agree with you! Have to go with your gut and do what you feel and know is in your best interest.

 

[nuttybrunette]

I, too, can’t stand trying to bend my knee at PT or OS while laying down. It just feels wrong. Tight, awkward, uncomfortable. I have serious ROM issues with my ankles tho. Could it be that ankles are your trouble too?

 

[Jockette]

I guess I occasionally try to do a strengthening activity to please other people and to prove to myself, and others, that it is not the answer.

@nuttybrunette I’m not aware of any ankle issues.

The only issues I had before surgery was pain when I sat down, got up, or did stairs. I could walk fine with no pain. I was told I was not bone on bone. I could wear pants!!!! Now, yes, that arthritic pain in my knee is gone, but it has been replaced with this awful, almost constant discomfort that defies logic.

 

[Celle]

I, too, can’t stand trying to bend my knee at PT or OS while laying down. It just feels wrong. Tight, awkward, uncomfortable.

So don't do it that way. Heel slides are just as valid if you do them while sitting on a chair.
Heel slides and how to do them properly
If the PT wants to measure, ask her/him to kneel down and do it. Remember you're the boss.

I always found that I could bend my knee much further when sitting on a chair than when I was lying down.

My surgeon doesn't measure ROM. He eyeballs it when he says "Show me what you can do."