Aa
Really feed up with doctors - not sure where to go from here
This post may be a little bit on the long side, mostly because it is a long story. But I think I have to tell it all in order to present the full picture of what has been going on lately.
First off is that I have been getting a lot worse over the last few months...More pain, balance problems, cognitive issues, shortness of breath...you name it and it has gotten worse. But the straw that broke the camels back was my appointment at the orthopedic clinic on Thursday.
I have had problems with my knees for about 40 years and it started when I was in the Navy. While in the Navy I spent several months in a medical holding company because of extreme pain in my left knee. At the time all they did was give me shots in the knee of Novacane and Steroids along with some type of Narcotic oral pain killer. At the time the treatment did no good at all to relieve the pain at all. It was only the fact that I was on crutches for several months with no weight on the knee that the pain finally eased to the point I could again resume normal duties. But that was only temproary as over the years I have had to have surgery on my left knee twice because the pain returned.
So last June when the pain in my knee was getting pretty bad I decided to apply for service connected compensation for my knee pain and a couple of other conditions I feel are a result of my service in the Navy. So finally in December I had an appoinment with a doctor at the VA regarding my claim for the knees. When I showed up for the appointment the doctor said I was there regarding my right knee. I explained to her that while I have problems with both knees it was my left knee that was really painful. She looked in my file and saw it was my left knee but the people that evaluate claims had indicated it was my right for some strange reason. Then two weeks ago I had another compensation appointment at the VA. I fugured it was maybe for my COPD (asbestos exposure) or PTSD (Veitnam) since I have any appointments for them yet. When I got there I was again seeing the same doctor I had seen about my knees and she was very nice to me and explained to me the VA had reffered me back to her because she had not given them a though evaluation of my right knee even though she had explained in her report to the VA the mix up in which knee was bad.
I had an MRI done in December of my left knee at the VA by order of my PC. When I saw him 2 weeks ago he explained the results and that I was going to have a appointment with an orthopedic surgeon and that he would explain what they would do in the surgery. That brings me up to Last Thursday's appoinment. After going through all the problems I have been having with my knee that included falling when it buckles, having to crawl around my house some days because I can put any weight on the knee, plus all of my other health problems the doctor went to check my MRI. When he came back he started questioning me about which knee was bad saying that the MRI indicates it is of my right knee. Don't they know left from right at the VA? But he did acknowlege that there is a tear in the cartillage in the knee. So what do you think he wanted to do? Yes give me shots in the knee of Lanocane and Steroids. I told him no way as I have had that treatment in the past with no help from it. So his next suggestion was to give me Ibuprofene, which I can take because of kidney problems. So then he suggested phyical therapy. I have been doing phyiscal therapy for my knees for 12 months already with again no help. Finally he said I should go out and buy some Glucosamine and take it for 5-6 weeks to see if that helps. So then I asked about some pain killers for when my knee is really hurting and his response was that they don't give out pain killers there and I would have to see my PC for that. What a crock! Since when don't surgeons give patients pain killers? Also the way the VA works I won't get to see my PC for 3 months which made no difference to this doctor.
Dennis
First off is that I have been getting a lot worse over the last few months...More pain, balance problems, cognitive issues, shortness of breath...you name it and it has gotten worse. But the straw that broke the camels back was my appointment at the orthopedic clinic on Thursday.
I have had problems with my knees for about 40 years and it started when I was in the Navy. While in the Navy I spent several months in a medical holding company because of extreme pain in my left knee. At the time all they did was give me shots in the knee of Novacane and Steroids along with some type of Narcotic oral pain killer. At the time the treatment did no good at all to relieve the pain at all. It was only the fact that I was on crutches for several months with no weight on the knee that the pain finally eased to the point I could again resume normal duties. But that was only temproary as over the years I have had to have surgery on my left knee twice because the pain returned.
So last June when the pain in my knee was getting pretty bad I decided to apply for service connected compensation for my knee pain and a couple of other conditions I feel are a result of my service in the Navy. So finally in December I had an appoinment with a doctor at the VA regarding my claim for the knees. When I showed up for the appointment the doctor said I was there regarding my right knee. I explained to her that while I have problems with both knees it was my left knee that was really painful. She looked in my file and saw it was my left knee but the people that evaluate claims had indicated it was my right for some strange reason. Then two weeks ago I had another compensation appointment at the VA. I fugured it was maybe for my COPD (asbestos exposure) or PTSD (Veitnam) since I have any appointments for them yet. When I got there I was again seeing the same doctor I had seen about my knees and she was very nice to me and explained to me the VA had reffered me back to her because she had not given them a though evaluation of my right knee even though she had explained in her report to the VA the mix up in which knee was bad.
I had an MRI done in December of my left knee at the VA by order of my PC. When I saw him 2 weeks ago he explained the results and that I was going to have a appointment with an orthopedic surgeon and that he would explain what they would do in the surgery. That brings me up to Last Thursday's appoinment. After going through all the problems I have been having with my knee that included falling when it buckles, having to crawl around my house some days because I can put any weight on the knee, plus all of my other health problems the doctor went to check my MRI. When he came back he started questioning me about which knee was bad saying that the MRI indicates it is of my right knee. Don't they know left from right at the VA? But he did acknowlege that there is a tear in the cartillage in the knee. So what do you think he wanted to do? Yes give me shots in the knee of Lanocane and Steroids. I told him no way as I have had that treatment in the past with no help from it. So his next suggestion was to give me Ibuprofene, which I can take because of kidney problems. So then he suggested phyical therapy. I have been doing phyiscal therapy for my knees for 12 months already with again no help. Finally he said I should go out and buy some Glucosamine and take it for 5-6 weeks to see if that helps. So then I asked about some pain killers for when my knee is really hurting and his response was that they don't give out pain killers there and I would have to see my PC for that. What a crock! Since when don't surgeons give patients pain killers? Also the way the VA works I won't get to see my PC for 3 months which made no difference to this doctor.
Dennis
Oh, man; civilian doctors are worse....?
Has the orthopedic surgeon mentioned anything about injectons of something like Synvisc or Hylagen? It's called viscosupplementation, and they inject this stuff made from a roosters comb; there's a synthetic version if you're allergic to chicken or eggs.
When the cartilage gets thinned, and there is fraying of the meniscus, you can get pain like you've described. The injections such as Synvisc put a cushion in there; I've had it help for several months, and it can be repeated without causing problems like steroid injections can (steroids don't help my knees).
After my last knee reconstruction, the surgeon trimmed so many frayed edges, loose bodies, and such, that I have a large area where there is basically no cartlage left in my left knee. I think too many surgeries can end up with a person needing a knee replacement. Your surgeon could possibly be trying to avoid that.
You might try asking about viscosupplementation. The lidocaine that they use during the injection can help for a few hours all by itself. Even without numbing medication, a good knee injection just feels like pressure, not pain.
As for arthritis, when the cartilage thins, the bones start getting more pressure on them, and arthritis starts to become an issue.
My best friend needs to take antibiotics before dental work; her dentist fills a prescription for her that will take care of several visits; so she doesn't have to rush around and get a prescription filled.
I would suggest you call again about that Rx, and tell them that you need to have your partial in order to eat and live a normal life, and need to have it taken care of soon.
Also, try calling the orthopedic surgeons office and see about getting a Synvisc or Hylagen injection on both of your knees. I think you get a series of three injections, a week apart.
Kathy
Has the orthopedic surgeon mentioned anything about injectons of something like Synvisc or Hylagen? It's called viscosupplementation, and they inject this stuff made from a roosters comb; there's a synthetic version if you're allergic to chicken or eggs.
When the cartilage gets thinned, and there is fraying of the meniscus, you can get pain like you've described. The injections such as Synvisc put a cushion in there; I've had it help for several months, and it can be repeated without causing problems like steroid injections can (steroids don't help my knees).
After my last knee reconstruction, the surgeon trimmed so many frayed edges, loose bodies, and such, that I have a large area where there is basically no cartlage left in my left knee. I think too many surgeries can end up with a person needing a knee replacement. Your surgeon could possibly be trying to avoid that.
You might try asking about viscosupplementation. The lidocaine that they use during the injection can help for a few hours all by itself. Even without numbing medication, a good knee injection just feels like pressure, not pain.
As for arthritis, when the cartilage thins, the bones start getting more pressure on them, and arthritis starts to become an issue.
My best friend needs to take antibiotics before dental work; her dentist fills a prescription for her that will take care of several visits; so she doesn't have to rush around and get a prescription filled.
I would suggest you call again about that Rx, and tell them that you need to have your partial in order to eat and live a normal life, and need to have it taken care of soon.
Also, try calling the orthopedic surgeons office and see about getting a Synvisc or Hylagen injection on both of your knees. I think you get a series of three injections, a week apart.
Kathy
Thank you both for your responses. It is so frustrating to get any medical help, even medicorotic help, these days. I am including in this post the radiologist reports on both of my MRIs of my knees.
Left Knee:
FINDINGS - The ACL, PCL, and extensor mechanism are intact.
The collateral ligaments are within normal limits. The popliteus muscle/tendon complex is unremarkable.
The lateral meniscus demonstrates minor free edge fraying.
The medial meniscus demonstrates undersurface volume loss of the posterior horn with oblique extension into the substance of the meniscus compatible with a shallow oblique undersurface tear.
There is mild free edge truncation, as well.
There is cartilage thinning within both the lateral and medial compartments without high grade focal defect. The patellofemoral compartment cartilage is preserved. There may be mild chondromalacia along the medial patellar facet.
Tiny Baker's cyst. The bones and soft tissues are otherwise unremarkable.
IMPRESSION -
1. Worsening of the volume loss/irregularity of the undersurface of the posterior horn of the medial meniscus.
2. Cartilage thinning within both the medial and lateral compartments without focal high grade defect.
Right Knee:
FINDINGS - The ACL, PCL, and extensor mechanism are within normal limits.
The LCL, MCL, biceps tendon, and iliotibial band are unremarkable. The popliteus muscle-tendon complex is intact.
The lateral meniscus is within normal limits.
The medial meniscus is within normal limits.
Mild cartilaginous irregularity within the weightbearing portion of the central lateral tibial plateau is identified. No definitive full thickness defects are seen. Suspect a focal area of
partial thickness cartilage loss along the weightbearing central portion of the medial femoral condyle.
There is partial thickness cartilage loss along the patellar apex.
No joint effusion. Small Baker cyst.
Within the medial suprapatellar recess, there is a small area of blooming measuring approximately 3 mm. This is nonspecific but may reflect a small loose body. Differential does include a small amount of periarticular fat insinuating into this region.
No evidence of stress reaction or fracture is identified.
IMPRESSION -
1. Cruciate and collateral ligaments are intact.
2. No focal meniscal pathology is evident.
3. Partial thickness scattered areas of cartilage loss are identified.
4. Possible small suprapatellar loose body.
5. Small Baker cyst.
I have had arthroscopic repair of my left knee twice before with the relief of pain that lasted 10-15 years each time. But these surgeons I saw said that surgery only provides short term relief so they only want to do it as a last resort. 10 to 15 years of no pain sure doesn't seem like a short term relief to me! They were also trying to tell me it is Arthritus (sp?). I sure don't see anything about Arthritus in the report. The last Orthopedic surgeon I talked to about knees with said my cartillage is very brittle, not arthritus.
I have taken Tylenol at high doses (but not over the limit) and it has no effect on the pain. I actually have been trying to have them fix both knees (with the left knee first because it is a lot worse). It seems to me though that by just looking at the MRI picture a doctor would be able to tell if it was of the left or right knee. So I guess these doctors aren't really looking at the pictures of my knee.
And as if this isn't enough, a few weeks ago I broke my partial upper denture. With my heart problems I am suppose to take antibiotics before any dental work. So I called to get the usual 3 day RX for them. They never gave me and Rx for anything. So until I get and Rx I can't get another partial made as the dentist needs to extract a couple of teeth first.
What makes this even a sad state of affairs is that one of the main reasons I started going to the VA was because the civillian doctors around here are worse than the VA when it comes to care.
Dennis
Left Knee:
FINDINGS - The ACL, PCL, and extensor mechanism are intact.
The collateral ligaments are within normal limits. The popliteus muscle/tendon complex is unremarkable.
The lateral meniscus demonstrates minor free edge fraying.
The medial meniscus demonstrates undersurface volume loss of the posterior horn with oblique extension into the substance of the meniscus compatible with a shallow oblique undersurface tear.
There is mild free edge truncation, as well.
There is cartilage thinning within both the lateral and medial compartments without high grade focal defect. The patellofemoral compartment cartilage is preserved. There may be mild chondromalacia along the medial patellar facet.
Tiny Baker's cyst. The bones and soft tissues are otherwise unremarkable.
IMPRESSION -
1. Worsening of the volume loss/irregularity of the undersurface of the posterior horn of the medial meniscus.
2. Cartilage thinning within both the medial and lateral compartments without focal high grade defect.
Right Knee:
FINDINGS - The ACL, PCL, and extensor mechanism are within normal limits.
The LCL, MCL, biceps tendon, and iliotibial band are unremarkable. The popliteus muscle-tendon complex is intact.
The lateral meniscus is within normal limits.
The medial meniscus is within normal limits.
Mild cartilaginous irregularity within the weightbearing portion of the central lateral tibial plateau is identified. No definitive full thickness defects are seen. Suspect a focal area of
partial thickness cartilage loss along the weightbearing central portion of the medial femoral condyle.
There is partial thickness cartilage loss along the patellar apex.
No joint effusion. Small Baker cyst.
Within the medial suprapatellar recess, there is a small area of blooming measuring approximately 3 mm. This is nonspecific but may reflect a small loose body. Differential does include a small amount of periarticular fat insinuating into this region.
No evidence of stress reaction or fracture is identified.
IMPRESSION -
1. Cruciate and collateral ligaments are intact.
2. No focal meniscal pathology is evident.
3. Partial thickness scattered areas of cartilage loss are identified.
4. Possible small suprapatellar loose body.
5. Small Baker cyst.
I have had arthroscopic repair of my left knee twice before with the relief of pain that lasted 10-15 years each time. But these surgeons I saw said that surgery only provides short term relief so they only want to do it as a last resort. 10 to 15 years of no pain sure doesn't seem like a short term relief to me! They were also trying to tell me it is Arthritus (sp?). I sure don't see anything about Arthritus in the report. The last Orthopedic surgeon I talked to about knees with said my cartillage is very brittle, not arthritus.
I have taken Tylenol at high doses (but not over the limit) and it has no effect on the pain. I actually have been trying to have them fix both knees (with the left knee first because it is a lot worse). It seems to me though that by just looking at the MRI picture a doctor would be able to tell if it was of the left or right knee. So I guess these doctors aren't really looking at the pictures of my knee.
And as if this isn't enough, a few weeks ago I broke my partial upper denture. With my heart problems I am suppose to take antibiotics before any dental work. So I called to get the usual 3 day RX for them. They never gave me and Rx for anything. So until I get and Rx I can't get another partial made as the dentist needs to extract a couple of teeth first.
What makes this even a sad state of affairs is that one of the main reasons I started going to the VA was because the civillian doctors around here are worse than the VA when it comes to care.
Dennis
I'm so sorry for all the cr ap you're going through. I know knee pain (5 surgeries between the two knees), and totally sympathize.
As my dad had to deal with the VA, I understand how hard it is to get quality care.
Can you write a letter to your PC explaining what you are going through, and how it is adversely affecting your quality of life? Too many shots of steroids in your knees can further break down the cartilage in your knees.
You could explain that you have tried all of their conservative measures already and that they aren't helping, and that you can't do the simplest every-day things because of the pain and instabiliy.
If they insist on saying that it is your right knee, agree to be seen for BOTH knees, and tell them in no uncertain terms, in writing, that it is your left knee that is bothering you the most and has been for years.
A simple arthroscopic repair of torn cartilage is quick, easy, and relatively inexpensive. If it's more involved than that, then they need to explain that to you. Ask if they think you need a knee replacement.
In the mean time, all you can do is take Tylenol (no more than 6 tablets a day, if you can take it at all), ice your knee, and do your physical therapy exercises to keep your strength up. And know that we care, and hope that you can at least get this pain under control.
Take care,
Kathy
As my dad had to deal with the VA, I understand how hard it is to get quality care.
Can you write a letter to your PC explaining what you are going through, and how it is adversely affecting your quality of life? Too many shots of steroids in your knees can further break down the cartilage in your knees.
You could explain that you have tried all of their conservative measures already and that they aren't helping, and that you can't do the simplest every-day things because of the pain and instabiliy.
If they insist on saying that it is your right knee, agree to be seen for BOTH knees, and tell them in no uncertain terms, in writing, that it is your left knee that is bothering you the most and has been for years.
A simple arthroscopic repair of torn cartilage is quick, easy, and relatively inexpensive. If it's more involved than that, then they need to explain that to you. Ask if they think you need a knee replacement.
In the mean time, all you can do is take Tylenol (no more than 6 tablets a day, if you can take it at all), ice your knee, and do your physical therapy exercises to keep your strength up. And know that we care, and hope that you can at least get this pain under control.
Take care,
Kathy
Dennis,
I had such hope for you and the VA system a few months ago when you joined us here - I hate to read that it has fallen apart for you. It has to be incredibly maddening to here these same recommendations over and over when you have already tried thme with no help.
As for the pain meds, I can't imagine any doctor not writing scripts - even my dentist will do that if I am in pain. I guess you have to seey our PC again for some help.
sorry you're suffering,
Lulu
I had such hope for you and the VA system a few months ago when you joined us here - I hate to read that it has fallen apart for you. It has to be incredibly maddening to here these same recommendations over and over when you have already tried thme with no help.
As for the pain meds, I can't imagine any doctor not writing scripts - even my dentist will do that if I am in pain. I guess you have to seey our PC again for some help.
sorry you're suffering,
Lulu
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