Wednesday, May 11, 2011

Confusion Abounds

in 2002 or 2003, I went to urgent care with sudden scary knee pain, had x-rays, and was diagnosed with osteoarthritis and a worn meniscus.

Since then, many medical folks have told me that worn meniscus can't be diagnosed with x-rays, but have confirmed that I have arthritis based on pain, popping sounds when I move the joint, and so forth. My rheumatologist agreed with the arthritis dx and gave me Relafen as an NSAID, because ibuprofen chews up my stomach too much.

Then my pharmacist told me that Relafen isn't an NSAID; he says it's a muscle relaxant.

Today, my orthopedist said I don't have arthritis but do have patellar tracking disorder: my kneecaps in both knees are off-kilter and don't move where they're supposed to, causing wear and tear and pain, although my right knee is much worse than my left. (He also says Relafen is an NSAID, and the All-Knowing Internet seems to agree; I'll tell my pharmacist this when I see him, since he was treating me a little like a drug addict for taking the stuff.) Orthodoc claims the condition's strictly structural and due to genetics, and says the only effective treatment of the cause -- rather than the symptoms -- is arthoscopic knee surgery to release the lateral ligaments.

First he said that surgery was a last resort, to be used only when the steroid shots don't work anymore. (He gave me shot #2 today, although shot #1 was nine months ago, which doesn't seem like a bad record.) Then, when I asked more questions, he said it was actually better to have the surgery sooner rather than later, because the longer you wait, the more damage is caused by the kneecap moving the wrong way. He said there's no downside to the surgery and that recovery time is quick. He had his nurse give me my diagnosis code and the surgical procedure code, so I could call my insurance company to find out what it would cost.

Important note: Orthodoc's retiring in a month -- he's been driven out of the business by the difficulty of trying to run a solo practice in today's insurance environment -- so he wouldn't be performing the surgery even if I had it. He has no financial incentive to push surgery, in other words (plus I was referred to him by a friend who says he's conservative in terms of surgery).

However, internet research suggests that this surgery a) actually is a last resort, b) often doesn't work (and may actually destabilize the knee), and c) involves lots of agonizing postop pain and weeks or months of PT even when it does work. The sites I've read say that full recovery can take up to a year.

No thanks.

Meanwhile, I think Orthodoc's nurse gave me the wrong codes, because when I Googled them, they were about meniscus tears and surgical repair of same, rather than kneecap issues.

My brain hurts. Thanks to the shot, my knee hurts less than it did, although not as much less as it did after shot #1. We'll see how it does over the next few weeks, though.


  1. Good sounds like these people don't know what they heck they are doing...pharmacists, one can agree on anything....time for a fresh start I'm thinking.

  2. Anonymous7:03 PM

    Hi Susan,

    It really sounds like you need to go shopping for both an orthopedist and a PCP. "I'm dissatisfied but I don't think anything else will be any better?" A sure sign that things need to change.

    As far as the orthopedist, you'd be surprised how treatment recommendations for knee pain can very. When my knee pain was very bad, I saw at least three different orthopedists. One said it's not a medical problem, I'm just made in such a way that I tend to be uncomfortable and probably pretty clumsy. The next one said I needed surgery. The last one said I just needed a very good bout of PT. (I didn't go for the surgery, and I've never regretted it.)

    Anyway, it doesn't sound like your orthopedic issues are going to be over when your current doctor retires, so that would be another good reason to look around. It might be a good idea to tell your insurance company you've gotten a recommendation for surgery but you want a second opinion.

    By the way, I hope your current exercise regimen includes strengthening your quadriceps, and that you always ice your knees for 10 minutes after every workout.

    Be well!




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