Day 60: Good News! (Sort Of)
OK, so my week 9 weigh-in was 298 lbs; the same as it was in week 8.
The pain in my left knee and the plantar fasciitis pain in my right foot have continued unabated, and I haven't walked a bit.
Ironic, isn't it, that a blog about a fat guy walking to lose weight has no walking?
Anyway, in my last post, I talked about having to cancel the appointment I'd made with the knee and foot specialist because I had food poisoning. I called back this week, and was told it would be four weeks before she could see me.
The pain in my knee hasn't been getting any worse, but it has become constant, rather than intermittent, as it was before. I decided I couldn't wait for the appointment with the specialist. The big practice she's a part of has an urgent care clinic, so this morning, I grabbed all my shoe inserts and went over there. Great idea! It was early on a Saturday morning, and no one else was there. I breezed right in.
There was a pretty funny element to it. When the nurse took me back to the examination room, she asked me what was wrong. I told her I had plantar fasciitis, metatarsalgia, and Morton's neuroma in my feet, and was afraid I might have medial meniscus tears in both knees. She looked at me oddly, and said: "Oh, have you already seen a doctor about this?"
I told her I hadn't seen a doctor, but I'd been researching it on the internet.
She literally tossed her head and said: "Humpphhhh".
I know medical professionals hate it when patients look things up on the internet and try to tell them how to do their jobs, but experience has taught me that I need to be actively involved in the process. In the spring of 2012, I got in a wreck on my motorcycle, and broke my right arm. fractured my left arms, fractured a bunch of ribs, and broke my favorite pinkie toe. The worst injury was my right arm. The distal radius was completely broken at the wrist, and required surgery. They inserted a plate and a bunch of screws.
He put me in a cast up to my shoulder. I started researching the injury on the internet, and learned the latest thinking was to not put it in a cast, but to put it in a frame with bolts holding the hand and wrist immobile, instead. That way, once, or twice a week, the doctor can unbolt it and manipulate the wrist. This yields much better outcomes, as far as regaining function. My doctor flat-out refused to even discuss it.
After six weeks in the cast, My doctor sent me to the physical therapy department at his clinic. Again, I'd been doing a lot of research, and told the therapist I wanted to start an aggressive program of assisted manipulation. He told me he couldn't, that the doctor was super conservative, and never allowed assisted manipulation.
Assisted manipulation is when you bend the wrist as far as you can, then the physical therapist "helps" it bend more. A LOT more. Multiple times. Another word for it is "torture". Everything I'd read, though, told me this torture was necessary.
You have ten "floating" bones in your wrist, surrounded by connective tissue. When the wrist is immobilized for great lengths of time (say, six weeks in a cast), the connective tissue adheres to the bones. The older you are, the worse this adhesion process tends to be; a 16 year old kid can spend six weeks with his wrist in a cast, and lose no movement. At my age, though, adhesion is a virtual certainty, and aggressive physical therapy immediately after getting out of the cast is critical in ameliorating adhesion.
I didn't get that.
Week after week, I'd go to the physical therapist two, or three times, and he'd do a gentle massage on the wrist (which felt great!), and have me do some very easy stretches and exercises. He was a great guy, and we became friendly. At one point, he told me he agreed with me, but he worked for the clinic, and the doctor was his boss. He had no choice.
So, I finished the twenty-week program with him, and my doctor told me I was healed, and had what I was going to get. What I had (and still have) was a stiff wrist with about 60% of it's range of motion, and constant pain; sometime bad, sometimes not so bad, but always there.
I finally went to another physical therapist, who was shocked at the treatment I'd had, which he described as "out of the 70s." He referred me to another orthopedist, who, as all doctors do, would not say anything critical of the doctor who'd treated me, but did say he would have done it differently. The treatment plan he described was exactly what I'd been pleading with my original doctor for.
By that point, all he said he could do was put me under anesthesia (because I'd never be able to tolerate the pain if I was conscious), and bend the wrist to "extreme angles" and hold it there until the adhesions came loose (if they would come loose). He said my wrist would swell up to the size of a cantaloupe, and I wouldn't be able to use it for a couple of months. I'm a poker dealer, and use that hand constantly, so that meant two-to-three months out of work. He said it would probably take two, or three procedures, that he couldn't guarantee a return to full mobility, and there was a risk of nerve damage.
Guess I'm sticking with what I have.
Several lessons learned:
1. Never go to a physical therapist who works for your doctor. If I'd gone to another PT, I could have had a say in my treatment.
2. Research your condition on the internet, and insist your doctor discuss your questions and concerns with you until you're clear on what that doctor is saying.
3. When you don't agree with your doctor, immediately go and get a second opinion. Don't just go along with what he, or she says.
Anyway, this morning, after the nurse left, the X-Ray guy came and got me, and took bunch of x-rays of my feet and knees. I then waited in the exam room for the doctor. As soon as he walked in, he said: "So, you're the guy who likes to diagnose himself on the internet!"
I just laughed. He was in his 40s, a former combat medic who had gone to med school after serving in Iraq, and who has foot and knee problems himself, and is a fellow dog lover, too. Really nice guy, actually. He consulted the x-rays for awhile, then thoroughly examined my knees and feet. Afterwards, he said: "Regarding your feet, you have plantar fasciitis, metatarsalgia, and Morton's neuroma."
I just looked at him, and we both burst out laughing.
He said my knee problems weren't meniscus tears, though. He said my problem was I had 56 year-old knees. The x-rays had revealed arthritis in both knees, and that was the pain I was feeling.
Now, normally, finding out you have arthritis in your knees might not be such a good thing, but compared to meniscus tears that will eventually require surgery, I'll take it. It goes back to the question of being hurt, or being injured. Torn meniscus are injuries, arthritis just hurts. Walking is actually good for arthritis, and the pain is something I can learn to deal with. At least I know walking on it won't injure it further, and that's a big deal.
He went over stretches I can do for the plantar fasciitis, which he also suffers from, and he said it can take a very long time to heal. We also talked about shoe inserts, and exercises I can do for my knees. I left feeling pretty good, and excited that I can resume Lily's walks.
Of course, it's 17 degrees, and sleeting, so I won't be resuming Lily's walks just yet.
When I got home, my new knee brace had gotten here. It's pretty cool.
The upper cross straps offer support right where I have the arthritis pain. I've been wearing it for about six hours, and haven't felt any pain at all, or even the "twinge" I constantly feel, so I'm really happy with it. Amazon had it for half price as a "used" item, but it looked brand new to me. They have one more in my size, so I'm going to get it for my other knee. It's not hurting now, but the doctor said the x-rays showed arthritis in both knees, so I know it's just a matter of time.
So, here's my plan.
I'm going to keep wearing my knee braces, and start doing the plantar fasciitis stretches the doctor and I discussed.
As soon as weather allows, I'm going to go back to walking Lily one mile per day.
I'm on vacation now, and go back to work on the 16th of January (11 days from now ). When I do, I'll go back to climbing the five flights of steps per day I was doing before the injury.
As soon as it feels comfortable, I'll step Lily's walk up to 1 1/2 miles per day.
As soon as that feels comfortable, I'll start dropping her off, and walking another 1/2 mile on my own, at a brisk pace.
As soon as that feels comfortable, I'll add 1/2 mile to that, and another, and another, until I'm up to my 3 1/2 miles per day in 1 hour target.
I'm going to take it slow, and careful, as I should have done at the beginning of this blog. I'm going to have to learn about managing osteoarthritis knee pain, and I'm going to have to take my age into consideration, as I'd never had to do before.
We'll see.
The pain in my left knee and the plantar fasciitis pain in my right foot have continued unabated, and I haven't walked a bit.
Ironic, isn't it, that a blog about a fat guy walking to lose weight has no walking?
Anyway, in my last post, I talked about having to cancel the appointment I'd made with the knee and foot specialist because I had food poisoning. I called back this week, and was told it would be four weeks before she could see me.
The pain in my knee hasn't been getting any worse, but it has become constant, rather than intermittent, as it was before. I decided I couldn't wait for the appointment with the specialist. The big practice she's a part of has an urgent care clinic, so this morning, I grabbed all my shoe inserts and went over there. Great idea! It was early on a Saturday morning, and no one else was there. I breezed right in.
There was a pretty funny element to it. When the nurse took me back to the examination room, she asked me what was wrong. I told her I had plantar fasciitis, metatarsalgia, and Morton's neuroma in my feet, and was afraid I might have medial meniscus tears in both knees. She looked at me oddly, and said: "Oh, have you already seen a doctor about this?"
I told her I hadn't seen a doctor, but I'd been researching it on the internet.
She literally tossed her head and said: "Humpphhhh".
I know medical professionals hate it when patients look things up on the internet and try to tell them how to do their jobs, but experience has taught me that I need to be actively involved in the process. In the spring of 2012, I got in a wreck on my motorcycle, and broke my right arm. fractured my left arms, fractured a bunch of ribs, and broke my favorite pinkie toe. The worst injury was my right arm. The distal radius was completely broken at the wrist, and required surgery. They inserted a plate and a bunch of screws.
After six weeks in the cast, My doctor sent me to the physical therapy department at his clinic. Again, I'd been doing a lot of research, and told the therapist I wanted to start an aggressive program of assisted manipulation. He told me he couldn't, that the doctor was super conservative, and never allowed assisted manipulation.
Assisted manipulation is when you bend the wrist as far as you can, then the physical therapist "helps" it bend more. A LOT more. Multiple times. Another word for it is "torture". Everything I'd read, though, told me this torture was necessary.
You have ten "floating" bones in your wrist, surrounded by connective tissue. When the wrist is immobilized for great lengths of time (say, six weeks in a cast), the connective tissue adheres to the bones. The older you are, the worse this adhesion process tends to be; a 16 year old kid can spend six weeks with his wrist in a cast, and lose no movement. At my age, though, adhesion is a virtual certainty, and aggressive physical therapy immediately after getting out of the cast is critical in ameliorating adhesion.
I didn't get that.
Week after week, I'd go to the physical therapist two, or three times, and he'd do a gentle massage on the wrist (which felt great!), and have me do some very easy stretches and exercises. He was a great guy, and we became friendly. At one point, he told me he agreed with me, but he worked for the clinic, and the doctor was his boss. He had no choice.
So, I finished the twenty-week program with him, and my doctor told me I was healed, and had what I was going to get. What I had (and still have) was a stiff wrist with about 60% of it's range of motion, and constant pain; sometime bad, sometimes not so bad, but always there.
I finally went to another physical therapist, who was shocked at the treatment I'd had, which he described as "out of the 70s." He referred me to another orthopedist, who, as all doctors do, would not say anything critical of the doctor who'd treated me, but did say he would have done it differently. The treatment plan he described was exactly what I'd been pleading with my original doctor for.
By that point, all he said he could do was put me under anesthesia (because I'd never be able to tolerate the pain if I was conscious), and bend the wrist to "extreme angles" and hold it there until the adhesions came loose (if they would come loose). He said my wrist would swell up to the size of a cantaloupe, and I wouldn't be able to use it for a couple of months. I'm a poker dealer, and use that hand constantly, so that meant two-to-three months out of work. He said it would probably take two, or three procedures, that he couldn't guarantee a return to full mobility, and there was a risk of nerve damage.
Guess I'm sticking with what I have.
Several lessons learned:
1. Never go to a physical therapist who works for your doctor. If I'd gone to another PT, I could have had a say in my treatment.
2. Research your condition on the internet, and insist your doctor discuss your questions and concerns with you until you're clear on what that doctor is saying.
3. When you don't agree with your doctor, immediately go and get a second opinion. Don't just go along with what he, or she says.
Anyway, this morning, after the nurse left, the X-Ray guy came and got me, and took bunch of x-rays of my feet and knees. I then waited in the exam room for the doctor. As soon as he walked in, he said: "So, you're the guy who likes to diagnose himself on the internet!"
I just laughed. He was in his 40s, a former combat medic who had gone to med school after serving in Iraq, and who has foot and knee problems himself, and is a fellow dog lover, too. Really nice guy, actually. He consulted the x-rays for awhile, then thoroughly examined my knees and feet. Afterwards, he said: "Regarding your feet, you have plantar fasciitis, metatarsalgia, and Morton's neuroma."
I just looked at him, and we both burst out laughing.
He said my knee problems weren't meniscus tears, though. He said my problem was I had 56 year-old knees. The x-rays had revealed arthritis in both knees, and that was the pain I was feeling.
Now, normally, finding out you have arthritis in your knees might not be such a good thing, but compared to meniscus tears that will eventually require surgery, I'll take it. It goes back to the question of being hurt, or being injured. Torn meniscus are injuries, arthritis just hurts. Walking is actually good for arthritis, and the pain is something I can learn to deal with. At least I know walking on it won't injure it further, and that's a big deal.
He went over stretches I can do for the plantar fasciitis, which he also suffers from, and he said it can take a very long time to heal. We also talked about shoe inserts, and exercises I can do for my knees. I left feeling pretty good, and excited that I can resume Lily's walks.
Of course, it's 17 degrees, and sleeting, so I won't be resuming Lily's walks just yet.
When I got home, my new knee brace had gotten here. It's pretty cool.
The upper cross straps offer support right where I have the arthritis pain. I've been wearing it for about six hours, and haven't felt any pain at all, or even the "twinge" I constantly feel, so I'm really happy with it. Amazon had it for half price as a "used" item, but it looked brand new to me. They have one more in my size, so I'm going to get it for my other knee. It's not hurting now, but the doctor said the x-rays showed arthritis in both knees, so I know it's just a matter of time.
So, here's my plan.
I'm going to keep wearing my knee braces, and start doing the plantar fasciitis stretches the doctor and I discussed.
As soon as weather allows, I'm going to go back to walking Lily one mile per day.
I'm on vacation now, and go back to work on the 16th of January (11 days from now ). When I do, I'll go back to climbing the five flights of steps per day I was doing before the injury.
As soon as it feels comfortable, I'll step Lily's walk up to 1 1/2 miles per day.
As soon as that feels comfortable, I'll start dropping her off, and walking another 1/2 mile on my own, at a brisk pace.
As soon as that feels comfortable, I'll add 1/2 mile to that, and another, and another, until I'm up to my 3 1/2 miles per day in 1 hour target.
I'm going to take it slow, and careful, as I should have done at the beginning of this blog. I'm going to have to learn about managing osteoarthritis knee pain, and I'm going to have to take my age into consideration, as I'd never had to do before.
We'll see.
posted by Sean at 2:32 AM
0 comments
