And Did I Ask You???

August 2, 2009 at 9:47 pm (Life) (, , )

Gaah, I didn’t ask for your opinion.  So don’t tell me what I’m doing is wrong and that I’m not trying hard enough.

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Ha, funny. Or not.

July 23, 2009 at 7:00 pm (Life) (, , )

I don’t like taking medication, of any sort.  No particular reason, other than I don’t like masking symptoms and I think medications are over-hyped and over-used.

Well, in the past 3 years, I’ve had a number of surgeons suggest a cortisone injection into my knee.  And every time I’ve said no.  I don’t think cortisone solves any problems it just masks the symptoms.  Last Thursday, I reluctantly agreed to try it.

Worst pain ever.

At first they said, symptoms may appear worse the first 24-48 hours (this is due to the cortisone crystalizing).  And to ice and take ibuprofen (cortisone is an anti-inflammatory steroid, why should I take another anti-inflammatory).  4 days late, I was still in a lot of pain, this time they said that pain may be present for up to a week and that I could take darvocet (I think not…).

The one week mark has come and gone.  As of today:

  • I have a very limited range of motion (pre-cortisone I had near normal range of motion)
  • My knee is still swollen
  • My knee is bruised (hasn’t been like that for a long time)
  • My knee has this constant sharp pain on the medial side (this hasn’t been a problem since the initial injury 3 years ago)
  • My knee still aches and hurts around the patella
  • I now have a sharp pain shooting up and down my leg
  • It takes less time for my knee to get tired when I’m standing
  • In the evening the muscles around my knee sort of spasms
  • I don’t know if my knee is still catching because I can’t move it

This stinks.  I didn’t want cortisone in the first place and its just making things worse…

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Good news, bad news

July 16, 2009 at 9:12 pm (Fun Stuff, Issues, Life, School, Summer 2009) (, , , , , )

Orthopedic appointment was bad.  He couldn’t see any problems with the articular cartilage on the MRI, so decided to try a cortisone injection.  I can’t remember the last time I was in this much pain 😦  But, he said that in a month we could reevaluate for another scope to clear out scar tissue and look directly at the articular cartilage.

But, while in Phoenix, we went to the Apple store and I got my new laptop (15 inch Macbook Pro).  And because I’m a student, it came with a new iPod touch and printer.

And, I got officially accepted into my degree program,  Yay.  Well, it’s pending copies of my official transcripts, but those are on order…

Oh, and sorry for not writing as much recently, there just hasn’t been that much going on around here…

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More Med Stuff

June 24, 2009 at 3:17 pm (Fun Stuff, Life) (, , )

This morning, I had another MRI.  I am probably one of the few people I know who actually enjoys MRIs; I like the whole futuristic feel, plus the science intrigues me.  So, you get to read a bit about it before I get to the main point of this post…

So, MRI, or Magnetic Resonance Imaging, works through the use of a huge magnet.  The units of measure for magnets are tesla and gauss; basically, 1 tesla = 10,000 gauss.  Well, the earth puts off a magnetic field of 0.5 gauss.  The high end MRIs use a 3 Tesla magnet, or 30,000 gauss, so it is pretty powerful.  Magnet fields also increase as your near the source (in this case the giant magnet).  T3 MRIs will quite easily pull metal objects out of your hand and across a room.

Ok, so the magnet itself is a Superconducting Magnet.  It is made up of coils of wire, through which electric current is passed to create the magnetic field.  The wire is also kept in liquid helium, which keeps the temperature at about 452 degrees below zero.  The whole magnet is kept in a vacuum, which acts as insulation.  (The cold temperature increases the efficiency of the machine, because the resistance within the wires drops down to zero).

Well thats all well and good, you go in the middle of a supercold magnet that weighs several thousand pounds, now for the Resonance part of MRI.  Ok, well the human body (like anything else…) is made up of billions of atoms, each spinning in every direction.  The MRI interacts only with hydrogen atoms, this is because hydrogen has only one proton, and a relatively long magnetic moment, which basically means that it has a strong tendency to line up with the direction of a magnetic field.  The MRI’s magnetic field runs lengthwise along the bore ad so when a person is placed in the field, all the hydrogen atoms line up towards the feet and head.

Then, the MRI machine applies a Radio Frequency that only affects the hydrogen atoms.  The Radio Frequency is emitted in a pulse directed at the area being examined.  This pulse causes the protons in that specific area to spin in a different direction at a specified frequency (this is called the Larmour Frequency).  The Radio Frequency is applied through a “coil,” which looks like a mini-MRI that just encloses the target area.  There are also three gradient magnets that can be turned on and off very fast in a specific pattern.  By doing so, the magnetic field is altered in a very specific area allowing images to be taken like slices of bread, but they are that are only millimeters thick.

So the Radio Frequency gets the hydrogen atoms spinning in a very specific area.  Then, the Radio Frequency is turned off, and the hydrogen alines itself with the magnetic field again, releasing all the excess energy.  This release of energy is a signal that can be picked up by the coil and sent to the computer system

The computer is able to take this information and convert it into images of the area in question.

 

Well, all that to say, I had another MRI of my knee today, but the earliest available doctor’s appointment was July 16………. sigh……….

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Brief Bio Lesson

June 5, 2009 at 12:41 am (Life) (, , , )

So, the knee is made up of three bones: the tibia (shinbone), the femur (thighbone) and the patella (kneecap).  Between the tibia and femur there is a cushion made up of the medial meniscus and the lateral meniscus.  The tibia and femur are held in place with the anterior cruciate ligament and posterior cruciate ligament; these ligaments go front to back and cross in the middle.  The tibia and femur are further stabilized by the medial collateral ligament and the lateral collateral ligament; supporting the inside and outside of the knee.  With me so far?

Then there is the patella.  The patella, like the tibia and femur, has a cushion layer, called the articular cartilage, the articular cartilage provides a smooth surface to slide across the rest of the knee as it bends.  The patella is held in place by the patellar tendon (technically a ligament, but thats not what its called), which connects to the tibia, and the quadriceps tendon, which (obviously) connects to the quadriceps muscle.

And there you have knee anatomy 101.

So, 3 1/2 years ago, I fell while cross country skiing, and apparently tore the meniscus (not good, there is limited blood flow there so it can’t really heal itself).  So we went to see Orthopedic Surgeon (hereafter OS) #1.  He recommended arthroscopic surgery.  Well, not knowing any better we went through with that without seeking a second opinion (I highly recommend a second opinion unless it is a dire life or death situation, or you have a good understanding about what is going on).  Surgery went well, went through Physical Therapy (PT) for several months.  I few months after surgery, I reinjured my knee either while running or in a defensive tactics class.  OS #1 suggested a second surgery to clear out scar tissue and what not.  Fine whatever, made sense at the time.  And for a while after the second surgery my knee seemed better, but then as I started doing more activity, it quickly got worse again. 

On to OS #2…  OS #2 ordered 3 months of PT for Patellofemoral Syndrome (the patella is not correctly aligned). This seemed to help for a while, but then sort of plateaued after a few months.  OS #2 then thought the best option would be to do exploratory surgery with the option of a lateral release (cutting the ligaments so they allow more movement), microfracture (drilling small holes into the bone to encourage scar tissue growth to fill in for any damaged cartilage), ligament repair, and meniscus repair.  Well, after the last experience we weren’t to thrilled about this option.

So, on to OS #3…  OS #3 did not think another surgery was warranted, and instead ordered several months of PT.  This helped increase strength and what not, but didn’t really help the problem…  OS #3 did suggest a cortisone injection.  But I think cortisone just treats the symptoms not the cause of the problem.

Well today, we saw OS #4.  He was adamant that he wanted to determine the problem before just treating symptoms or randomly cutting open my knee again.  He appeared to think it was quite obvious that the problem is centered around the articular cartilage (which is something I’ve been thinking for the past year or so based on what the physical therapists and google have told me).  So, he wants a new MRI taken.  Apparently it is hard to get a good image of the articular cartilage, and even harder to have a radiologist who can read images of the articular cartilage, but apparently he knows a radiologist who can do this.  So, hopefully, these images will show if the articular cartilage in my knee is “rough” and so causing the joint to catch as it moves or if it is “patchy” and so there are areas where bone is hitting bone.  If it is rough, OS #3 will probably recommend a surgery to smooth out and polish the cartilage allowing it to move smoothly.  If it is patchy, he will probably recommend ACI; this procedure involves removing cartilage cells, cloning them, grafting the new cartilage into the joint, and then about 2 years of rehab (yikes! but sounds kinda nifty, and if it works, I can’t complain too much…)

So yeah, its a little confusing.  But, hopefully in the next week or two I’ll have even more information!

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Maybe Another Knee Surgery

June 2, 2009 at 10:09 pm (Blogs, Life) (, , , )

Well, on Thursday I am going to see yet another orthopedic surgeon to get yet another opinion about what to do with my knee… sigh….

At this point yet another surgery seems imminent.  Sigh.

Anyway, one of the surgeries that might be considered is Autologous Chondrocyte Implantation, which repairs/replaces the “patchy” cartilage on the back of the patella, but it has killer-long rehab.  Well, I found a blog, Jim’s Bionic Knee that chronicles Jim’s ACI rehab.  It has a lot of good information, and is really funny.

I’m mostly posting this link for my reference, but its actually quite entertaining, so you might want to check it out too.

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