Friday, June 01, 2018

Got Myself To The Doctor: I'm Internally Deranged!

     My orthopedic physician -- the guy who fixed my knee a decade ago -- has a first-rate assistant, essentially a specialist Nurse Practitioner,* who handles much of the intake and routine work (surgeons are better off spending their time in surgery and he's a particularly good one).  My blowed-up knee is pretty much the usual thing in her line of work.  They got me in promptly and took a set of X-rays showing all the standard angles (and the three remaining screws that hold the end of my thighbone together in a pattern that shows the path of the original spiral fracture).  She looked them over, then talked me through them, with a likely prognosis and conservative treatment plan.

     The cartilage on the distal condyle continues to wear.  There's a visibly smaller gap there (cartilage is largely radiotransparent)  compared to the other three bearing surfaces of my knees.  It's now officially both "arthritis" and "internal derangement."

     She gave me a steroid shot right in the knee:  "Try to relax."
     "I'm trying...."

     She's also sentenced me to four weeks of physical therapy, twice a week.   Like I have time for it?  But I can't not have time for it, so I'm off to see if there's anything nearby or, failing that, anything near work.

     Also, I'd switched from ibuprofen to aspirin for my 3x/day routine of acetaminophen and an NSAID, on the notion that aspirin has some hearth-health benefits and "vitamin I" is very much the other way.  Bad idea, she tells me --  ibuprofen is a much better anti-inflammatory, if you maintain a steady level.  So I'm back on that, three of 'em, three times a day.
* Unless there's something in between N-P and M.D.; she's got that kind of no-nonsense competence and manner that bespeaks a great depth of knowledge and experience.  People who don't blink at my vocabulary or hold their own back are a delight to converse with and she's one.


Carteach said...

I found there's something about the combination of Acetaminophen and Aspirin that accentuates the pain relief. Two of each in strength, and I can hobble with my students for half a day while ignoring the pain.

Vitamin I I'm mostly trying to limit. The Doc's I see are not fans of it, unless really needed.

I'm going in next week for an entire newfangled knee installation. I figured it's time, as what I have now is missing too much stuff to ever get better. It just gets worse.... and that's not a path I wish to hobble down.

Jerry said...

Did your practitioner discuss a Hyaluronan (Synvisc) injection? It varies from person to person but my wife has had very good results.

Merle said...

Finding a good medical team is one step more important than finding a good mechanic....

Jerry said...

No fooling. Few people realize that just about any college degree can be used to gain entry to medical school. I've experienced a few doctors who I am convinced their original degree was in underwater basket weaving or Elizabethan poetry.

I once had a neurologist whose original degree was chemistry though. He was one of the few doctors I knew who could read the chemical formulas from his Physician's Desk Reference and make intelligent decisions regarding medications.

Antibubba said...

There's also Physician's Assistant.

Fuzzy Curmudgeon said...

I’ve been on two OTC naproxen twice daily for arthritis for several years. When we had Blue Cross and generics were $5 a prescription, I was getting the 500mg tabs, one tab twice daily, instead. Then we switched to UHC and scripts got more expensive, so I switched to OTC. Anyway, Vitamin N works better for me than Vitamin I. And I still take a low-dose aspirin daily, on advice of physician.

My wife would say, “get in the water!” for your PT, but she’s been telling me that for years and I hate getting in a pool.

John in Philly said...

Internally deranged is but a letter different from infernally deranged, and I think sometimes I am both on the same day.
Replacing failed/failing body parts has been a godsend for several members of the family, and the improvement of quality of life has been huge and long lasting.
Good luck no matter what you choose.

Roberta X said...

Antibubba, that's her. She's a PA!

pigpen51 said...

I routinely see a PA at my urologists. She is the one who got my chronic kidney stones to finally cut back to only once a year of so, instead of every month or two. That is a pain in the, well, you know what, that I don't miss. I have had women who have given birth and also had kidney stones, who said they would rather give birth, as it was less painful. I don't know about that, but I know that at times, some of the kidney stones I have had have dropped me right to my knees on the floor, and also made me vomit in the E.R. in their sink. I am never afraid to see a PA or a Nurse Practicioner. They are never allowed to do more than they are qualified for, and without fail, they are extremely knowledgeable, and efficient. Some have been better than the doctors, since often the doctors have the God syndrome, and the PA's and NP's seldom do.