Tuesday, July 29, 2008

This Pain in My Knee is a Pain in the Ass

Just got back from the doctor, and the x-rays were fucking normal. The verdict: Patellofemural Pain Syndrome.


Why do I say "ugh"? Because it means they can't fix it with surgery, won't go in with a scope to see what's under the kneecap, won't spring for more effective imaging than an x-ray, and pretty much the only treatments available are the ones I've already been using with less than spectacular results. Those treatments--taking painkillers, walking to relieve the discomfort, and applying ice--are either inconvenient or of questionable effectiveness.

How much does it hurt? Well, speaking as someone who has given birth to an 11+ lb baby the natural way, this latest flare-up--at its worst--hurt as much as early to mid-stage labor. Only you don't get that couple of minutes between each wave of pain--it just hurts all. The. Time. And it isn't dull or throbbing, either. It's like someone is jamming a knife under your kneecap.

All. The. Time.

The swelling is disturbing. The heat of the inflamed tissues, even immediately after you take the ice pack off, is alarming. Advil (even twice the maximum recommended dose) does not touch this pain. Codeine is its bitch. The only things that have worked for me is walking, and ice. Unfortunately, I can't even use this as an excuse to take time off work--being a waitress means my job is like physiotherapy.

Not being somnambulatory, I am left with one option at night. Every three hours or so, my knee wakes me up to let me know my ice pack needs changing. The walk to the freezer is a welcome relief, and by the time I return to bed, I can usually almost stand it. Sometimes, I need to walk circles in the living room for five or ten minutes before I can lie back down.

Of course, this flare-up could not have happened at a worse time. Sitting hurts. Driving is excruciating. Driving six hours so I could sit through my cousin's wedding ceremony and reception dinner was agony, even with an inexhaustible supply of ice from a cute bartender at the reception, and enough codeine to drop a bull elephant. In spite of all that, I managed to have a wonderful time. My cousin was handsome and charming, his bride beautiful and gracious. The ceremony was short and sweet, the venue stunning, the weather glorious, the food delectable and--most importantly--the bar open. Wild horses stamping violently on my bad knee couldn't have dragged me away.

That was more than a week ago. The pain and swelling have mostly subsided now, but the doctor gave me a prescription for naproxen sodium to take the next time it acts up. Of course, after looking at the list of side-effects in the product monograph, ice is looking better all the time. Generally, ice doesn't give you intestinal bleeding, heart attack or stroke.

But ask me again during the next flare-up. I'm notoriously fickle when I'm in agony.


Madame Butterfly said...

Oh crap! That really sucks. Do those flare-ups happen often?

naproxen sodium?

I just looked this up and it's Aleve.

Isn't that like the same thing as Advil. I've tried Aleve, does diddly squat for me.

I hope your Doc, didn't do what a Doc here did for a coworker---just give her a script for 600mg of Advil. *snort* She could just buy it over the counter and take 3 of them at a time.

Seriously, that really sucks. I feel for you.

But it is nice that you got to go to your cousin's wedding anyway and that you did have some fun. :)

kirsten saell said...

Naproxen sodium is similar to ibuprofen (they come from the same basic molecule, IIRC), but stronger. And of course it has more severe side effects. My grandmother took it for years for her osteoarthritis and ended up with bleeding ulcers.

Still, if it works, any port in a storm, right?

I've had flare-ups every now and again since I was about 14. Maybe four or five a year. But never like the last two. Never ones that kept me awake at night, or had me squirming in my seat. Never ones that a judicious mixture of advil, codeine and booze couldn't wrestle into submission.

I don't tend to get loopy when I take codeine--I would have to take eight T-1s to get noticeably smiley (and at that point, you're ODing on the acetaminophen). But the other night at work I was seriously messed up, and still couldn't sit down for more than 30 seconds at a time.

You're right, MB. It sucks. But the wedding was blammo. :)

Nonny said...

Codeine is a pretty mild painkiller. If you're having pain through it, you might want to talk to them about something stronger. (You also may want to talk to them about something without acetominophen if you're going to be taking it regularly. Tramadol is an odd one that's somewhat frequently prescribed for chronic pain patients and doesn't contain acetominophen. I say odd because it's a synthetic narcotic; while it stimulates the narcotic receptors, it isn't actually an opiate.

Also, aleve is pretty weak for dealing with knee problems. I have chrondromalacia (basically, weak ligaments and collagen) and I used to get Orudis KT (ketaprofen) OTC. I think they discontinued it because it didn't sell well, but you might talk to your doc about it. It's related to ibuprofen, but stronger, and is the only damn thing I've found to help when my knee is flared up, inflamed, and swollen.

By the by... if your doctor refuses to do more effective imaging than x-rays, he's an idiot. There are TONS of things that could be wrong that would NOT show up on an x-ray. Is seeing somebody else an option?

kirsten saell said...

Hey, Nonny!

Well, being that this is Canada, and health care is "free", the dynamics are totally different from those in the U.S. Even if I was willing to pay to get an MRI or even an ultrasound, the Canada Health Act prohibits it.

On the other hand, if the naproxen sodium doesn't work, I can go back in (at no charge) and get something stronger. I'm not too interested in a narcotic (or simulated narcotic) because other than improving my mood, they don't seem to do a whole lot for me. (And frankly, demerol was useless during labor, and I can only assume would be equally useless for this.)

My doctor suggested I might benefit from injections of cortisone on site, but I've heard they can cause damage to the joint. And he didn't completely rule out other options. But "free" medical care still comes at a cost, and that cost is mostly measured in time. If the naproxen doesn't work, I'll go back in and get something stronger. If that doesn't work, I'll go back in and get an ultrasound. If that doesn't reveal the problem, they won't just leave me twisting in the wind.

But it is largely a numbers game: they're betting it's patellofemural syndrome because that is the least expensive to diagnose and treat. If it turns out that isn't the case, they'll look at the next least costly thing.

Not necessarily the best system, but it won't put me in the poorhouse, either.

But in the meantime: Fucking ow!

Madame Butterfly said...

My grandmother took it for years for her osteoarthritis and ended up with bleeding ulcers.

Not any help with your pain, but if you have to take those kinds of meds that mess up your stomach you can always take prilosec.

I've been on prilosec for a couple of years and if I don't take it, I get really bad heartburn. It works really well, but I don't know what the long term effects are of taking it.

Another Suburban Mom said...

I feel for you. Could you have massage or Physical Therapy.

Your cousin's wedding sounds like it was great. I love me some open bar and appetizers.

Seeley deBorn said...

Wild horses stomping on your knee might not be a bad idea. At least then you'd qualify for surgery or something.

kirsten saell said...

if you have to take those kinds of meds that mess up your stomach you can always take prilosec.

Yeah, MB, that's what I'll probably do. But you can still end up with damage to your stomach lining. We'll have to see what happens during the next bout, when I start taking them.

I feel for you. Could you have massage or Physical Therapy.

Thanks, Suburban mom. Massage is iffy, especially during a flare-up. The tendons under the kneecap are so inflamed that even sitting with the knee bent hurts like crazy, so my first impulse is to leave it alone. When it's not acting up, that's when you do physio, but that all consists of stuff you can easily do at home--standing in a semi-squat position (actual squats aggravate it) for extended periods, walking uphill but not down. I've been thinking about arch supports, since it's been posited that flat feet contribute to the problem, but the damn things hurt. My feet want to be flat, dammit. And if it was my flat feet, wouldn't my left knee bug me, too?

At least then you'd qualify for surgery or something.

LMAO! You're so practical, Seeley. And yeah, they can really play this cost/benefit game with me because this isn't life threatening, and doesn't even keep me from working. It just fucks my leisure time right up the ass.


laughingwolf said...

sorry to hear of your pain, k... :(

i fell into rocks, thursday, xrays showed nothing broken, but still am in a lot of pain... should have gone fishing off the pier, instead....

kirsten saell said...

Oh, no, laughingwolf! That sucks, although it's good to hear the x-rays were clear. Maybe you should give up fishing altogether and take up needlepoint instead. Hope you feel better soon. Did they at least give you some good drugs?

I kinda did the same thing about a month and a half ago--stepped carelessly onto the mountain of shoes by my front door (damn kids) and sprained my ankle. Went down like a felled tree, but less graceful. It's still a bit swollen and achy, even now.

Good thing it's the same leg as the knee, just in case I opt for amputation, as my sister the doctor suggested, lol.