Tuesday, March 14, 2006

Knee Saga Update

I went to my first physio appointment last night, it was really great, I love my physiotherapist. She examined my knees, then she took out a pen and marked the boney landmarks of my two knees on my skin and showed me - what I've been saying all along - they are no longer the same. The left knee-cap, the one that hurts, is being pulled off to one side.
Generally, the patella (knee-cap) is suspended in it's groove over the bottom of the femur (thigh bone) and the top of the tibia (shin bone) by several different tendons. The tendon that attaches it to the shin and keeps it from getting too high on the knee is called the patellar tendon. That's the one the doctor thought was the problem from the x-ray last week, based on the height of my patella (knee-cap).
What the physiotherapist said was that indeed, from feeling it, the patellar tendon is harder than it should be, and stretched taught when there should be some give. But also, the kneecap is off kilter at the top (as in closer to my head). There is a band of connective tissue that runs along the outside of the leg and attaches to the outside of the top of the patella and that's pulling the top of the patella up and to the outside. Also the quadriceps (the muscle on the front of the thigh) attaches to the top of the patella in 4 places, hence the name quadriceps. Anyway, one of the places the quadriceps attaches to the patella is towards the inside of the knee, so it should pull the top of the knee-cap to the centre in opposition to the band of connective tissue that pulls it to the outside, but mine is attrophied from not using it a few months. So the outside one is too tight, the inside one is too loose and as a result the top of the kneecap is being pulled to the outside.
Anyway, she marked my boney landmarks and it was pretty clear how my right leg was great and my left leg was all out of whack, then she cracked out a model of a left knee and we looked at that, then she drew some diagrams for me on the wax paper of the examination table, and at the end of the visit she taped my knee cap over into the spot where it's supposed to live.
It was a relief to me to have someone agree with me, that my knee was, in fact, messed up. I was incredulous that the doctors I saw couldn't see what was plain as day to me. When the medical types actually explain the process of diagnosis and what clues they are using to come to their conclusion, it makes it so much easier and more understandable, and satisfying. The ones who won't talk it out with you are so aggravating. Here's a paraphrased comparison of my conversation with one of the doctors and the physiotherapist:

Jennifer- "So I'm here because I've been having knee pain in a knee that I broke 5 years ago."
Doc looks at knee
Doc- "No there's nothing wrong with you. And I can't see any evidence that your knee was broken"
Jennifer- Thinking, wasn't my telling you that I broke the knee evidence? "What about the pain I'm having?"
Doc- silence
Jennifer- "It makes a grinding noise when I walk. What is causing that?"
Doc- "We don't worry that much about knee noises. Joints make noise."
Jennifer- "So what's your suggestion. How can I make this better?"
Doc- "Get new gym shoes."

Jennifer - "Why does it make that noise when I straighten my knee? I'm afraid I'm damaging it when I hear that grinding."
Physiotherapist- "The sound of bone grinding on bone is unmistakable, you'd know if it was that, and you'd be in a lot of pain. Sometimes the fluid in your knee, that your knee-cap floats on, becomes viscous and gets so thick that it actually causes joint noise."
Jennifer - hallelujah! An explanation! A weird explanation, but it's a heck of a lot better than 'I don't care about your knee noise.' Why the heck couldn't the first doc have said that instead of leaving me wondering for months whether I was grinding the cartilage of my joints, or had arthritis in my twenties. I get that joint noises are common, all my joints occasionally make noise. But only my knee consistently makes noise, every single time, and a sickly slightly gringing noise, not like regular joint noises.

I did a little illustration to go along with my explanation of my knee problems, you're welcome to click the title of the blog to get there, or use this address http://artpad.art.com/?iw4ntb1ij88g. The two upside down triangles with the grey edges in the middle are meant to be the knee-caps, the red lines are tendons and other non-boney things that attach to the knee-cap.

So I'm a happy camper today. I'm not sure I'm looking forward to the therapy, but I'm definitely looking forward to the part after the therapy when I'm not in pain any more and I don't have to climb up and down stairs like a gimp, and I can exercise and kick everyone's ass at the weightloss challenge. I'll even do all my physio homework, cross my heart and kiss my elbow!


Trib said...

It sounds like you've got yourself a great doc. I hope physio is more productive than painful!

yrautca said...

Oh I hope you feel better in your knee soon. I do feel for you.

Also makes me wonder whether a free-for-all healthcare system in Canada results in doctors not being that attentive to their patients.

Please do not try and exercise using that knee. You dont need it to keep winning on the Loser Blog.

Princess Pessimism said...

So....wow....um. I was in physio for years for my ankle, before and after surgery. The only thing she ever did was give me electric shock therapy, and poke me....oh and yell at me, because I wasnt doing what she suggested...although, she never suggested anything...not even any stretches.

Px said...

my ankle clicks and grinds all he time since i shattered it, it's to do with the fluid and the fact that when they reset the bones and pinned them together again. they put them off slightly from where the bones have worn down slightly, so i'm making a new groove now

Miss Ash said...

Good to here that someone actually has a brain over there. As for the whole knee thing, perhaps you should not get soooo drunk where you are falling down stairs and injuring yourself :)

Jennifer said...

PP, you should have gone somewhere else. Thats bad service, and you seriously needed physio on your ankle.
PX, clicking and grinding! Shudder! The thought of that makes my stomach turn. Ankle injuries are even harder than knee injuries because the ankle is also load bearing, but there are so many more parts. I hope you rest with it propped up.
Yrautca, doctors in Canada still only get paid per visit, they are not directly employed by the government. What we have is socialized health insurance. So you get your qualification and you join a practice or set up on your own. And when a patient comes to visit you, then you bill the health insurance for whatever service you provided. So if you suck, and you are rude, and people don't want to go back to you, then you won't get any business. We all have the choice to go to whatever doctor we want, and they don't get paid if no patients visit them. As for referals, if you suck and you are rude, then family doctors won't refer patients to you and you won't get paid. I went back to my family doctor and told her that the referal with the first guy sucked and she was pissed off that he gave me the brush off and took note of it.
The only thing that's really different about our system is that doctors won't usually prescribe you any treatment that they consider unnecessary. So, in the US if you are a hypochondriac and you are prepared to pay out of pocket to have some ridiculous tests run, you could get them done. In Canada if you went to the doc and said you wanted to be tested for illnesses you couldn't possibly have, the doc would say, no, you don't need it. And if you really wanted it, you could go to the US and pay out of pocket for it there. Hence all the ads we have on local television in Toronto for Buffalo MRI.
Think of it this way, in the US you can buy health insurance from any number of insurance companies and HMOs, in Canada we have only one insurance company and it offers cheap cheap rates, and is free for people who can't afford it, but they get the same level of coverage as people who can more than afford it. So the doctor end of it is the same, they perform the service and bill the insurance. Just the insurance is different.

I think the heart of the problem, in Canada and the US, is that women's complaints are often ignored because doctors think that they are just bitching when there is nothing wrong with them. Doctors often think that if a guy goes in to their office, he's probably really sick because guys never go to the doctor, but if a girl goes in, it's just because she is hysterical and isn't really sick. Unfortunately, while women will go to the doctor, they very rarely are assertive enough to keep going back until their problem is solved satisfactorily. I'm pretty dogged when it comes to getting my problems solved and I'll just keep going back and back, but even I have given up in frustration.
Here's an example, Sly had some abdominal pain one Friday night. A stabbing pain in the centre of her lower stomach a few inches below her belly button. We were all already out at the bar and had had a drink or two. So we go down to ye olde emergency room and we present this problem to the doctor on call. He takes her for a party girl, tests her for STDs, which all come out negative, doesn't find any conclusive answer and sends her home. Four weeks later same problem, same result. The times I was there, of course, I asked the tough questions.
As it turned out, they couldn't diagnose without an ultrasound, and you can't have an ultrasound at midnight on a Friday, and you have to have the ultrasound while you are having the pain.
One time I lost my temper with the doctor and asked if we could make a reservation to have a nicer room next month and he said he didn't feel that it was a productive thing to say, and I said that if he was being productive and coming up with a solution, then I wouldn't have said it.
This went on for over a year. And then one day it happened on a Tuesday morning. Sly woke up with the pain and wondered if it was worth going to the ER, because they'd just make her wait and jerk her around. But thankfully, she realized that this was a golden oportunity to get her ultrasound while she was having the pain. She got a zealous young doctor and he even went for the MRI. Turned out her appendix had been swollen and leaking the entire time, but they missed it because the pain was in the centre and not to the side where appendix pain usually is, and because they were so invested in the idea that it was her female parts that they didn't bother to check everything else. She had to have the full surgery instead of the laproscopic job because the appendix had already leaked. Her recovery took quite a while.
A month or two later her boyfriend had stomach pain, and went to the hospital, they whipped his appendix out the same day with a laproscopic surgery and he was back in class the same week.
God forbid you come in with an atypical presentation as a woman, they'll immediately think it's all in your mind, or that it's your girl parts that are making you sick. Female heart attack patients have the same problem.

It might be nice to think that privatizing health care and making it all capitalist would make it more efficient, but the Canadian healthcare system is cheaper per capita than the US, and every single person is covered. Our cost per covered individual (which is everyone) is 40% less than your cost per covered individual (which is about 40% of your population). In total you are paying more for fewer people to be covered.

Here's a tale of my experience with private health care. The dentist in Canada is not covered by socialized insurance. You want dental work, you need private dental insurance or to pay for it out of pocket. I've had a toothache in my top right first molar since the late 90s, I've been poked by endodontists, I've had the root vitality test which is excruciating three or 4 times, I refuse to have it any more. I've had X-rays from angles that I didn't even know were possible, I had to go to a specialist to get a below up X-ray. Short of doing a root canal on a still living tooth, or getting it pulled and having an implant there's nothing they can do for me. Now I go to the expensive dentist, I have some really swank dental work, I live like a student, but my teeth are the one thing I'll really shell out money for, and yet I've been chewing on the left side for the last 7 or 8 years. Dentists can't be any more private than they are in Canada, so explain to me how we can use capitalism to get my tooth-ache cured.

Jennifer said...

And thanks Ash, now my mom thinks that I broke my knee when I was drunk.

Trib said...

Here in America we have a term for sending people with appendicitis home: malpractice. This is my problem with the ER, it seems like they're always cutting corners. Send her home without even a presumptive diagnosis? Did he even do a pregnancy test? Start to finish: bullshit. He should have worked her up. And what's atypical about appendicitis beginning with periumbilical pain? The only thing atypical is that they let it go on for a year. At least she didn't die of peritonitis.

And private health care and insurance are coming to Canada. Good or bad, who knows. I do know that your health care delivery is better than ours.

Has anyone considered TMJ?

Jennifer said...

TMJ? Do you mean the temporomandibular joint? Do you mean about my tooth? The problem is only one tooth, no headaches, I've been having swelling on the roof of my mouth and they made me give up popcorn, the tooth gets loose feeling and sore, but here's nothing in the X-rays, the root is still alive.

I know that health care is on the verge of being privatised in Canada, it's sad. Fuck Stephen Harper, fuck him in his stupid ass.

You're right about the malpractice thing, but it wasn't just one guy, it was quite a few, the thing they couldn't seem to get over was that the pain had somehow gone into sync with her menstrual cycle and that the pain was in the centre and not to the side. The did do a pregnancy test.

Trib said...

Yeah, by TMJ I actually meant all clenching. Just saying clenching is probably more correct. Sometimes my teeth hurt from that. Are they sure it's not an abscess?

Px said...

i don't rest with it propped it, it was years ago when i did it, i was walking on it after 3 months and running on it about 2 months after that
i broke my 5th metatarsel last year ago in the same foot, i did it playing football and the dr couldn't believe i'd been playing football on it

Jennifer said...

PX, you sound like my brother who has broken everything at some point and still insists on playing rugby.
Trib, You're right about the clenching, the pain in my tooth became much more bearable when I got a mouthguard for grinding (woke up this morning with such a clench going I thought the mouthguard would break), but the tooth pain, alas, predates the grinding. Unless there's an abscess that's invisible to the Xray, there's no abscess. Although, out of curiosity, what do they do in the case of an abscess. I've seen skulls in anthro class from ancient Egypt with abscesses that were never treated and went up into the sinuses, that must have been so freakin' painful.

Trib said...

Dentistry is not my area, but after I did some looking up it seems that your docs were suspecting a periapical abscess which is why they were testing your root (I hadn't known the pathophysiology until just now, whoops!) which probably would have shown up on xray, but they had enough suspicion that they followed up anyway. I was actually thinking of maybe a chronic gingival abscess which might not show up on xray, but also it might be obvious to them just from examination that it's not that. Is your breath bad? All abscesses are drained. Root canal in the case of periapical, just drained otherwise. If it weren't for the swelling I'd just think it was clenching. If your dentist hasn't checked your bite he should. If that's fine you should consider yoga and/or meditation. Reduce your stress levels. Stop drinking coffee. That sort of thing. Sort out whatever emotional turmoil may be effecting you. Good diet and regular exercise. It's very difficult to tell when any of this started since it happens at night. I had to have someone tell me that I was grinding my teeth. Also, your teeth should not be in contact most of the time, relax your jaw.

Jennifer said...

My breath is fine.
The dentist eventually came to the conclusion that the tooth was cracked (microscopically), but they wouldn't tell me how they knew that. So I said that until I got an explanation I wouldn't have any work done. I hate shifty medical proffesionals, is it so hard to just go through the process with someone, especially if they ask. i.e. you described a pain here, which makes me think that you either have a, b or c. It's probably not a because x, and it's probably not b because y, so that leaves c. Is that so hard?
What do I get? One look in the mouth after 8 years of pain from one endodontist,
Dr. - you have a crack, you'll need a crown which will cost 1500$.
J - What makes you think my tooth is cracked?
Dr. - It just is cracked.
So I go back to my own dentist.
Dr. - so I got the report from the endodontis and he says your tooth is cracked and you need a crown.
J - if this is so obvious, then how come you couldn't have diagnosed this 8 years ago.
Dr. - cracks are hard to diagnose they can be microscopic and don't show up in X-rays.
J - if that's the case then how come you know it's a crack now.
Dr. - because the endodontist report tells me so.
J - how does the endodontist know?
Dr. - silence
I go to medical professionals who are highly recommended and well respected, why do I keep running into the same problem? Does everyone else just bumble through appointments and take what the doc says as gospel and never ask a single question? Am I the only bitch out there who wants to understand what they say?

I do do yoga already and I never drank coffee. If there's a reason behind my grinding, it's probably a general dissatisfaction with life, and the residual effect of a horrible job I had last year that still gives me flash-backs.