Morgan's Visit to Lafayette

I wanted to post a few more photos from my niece Morgan's visit. I cannot imagine Morgan could wish for more wonderful parents and doting Grandparents!

Flying with Daddy

Playing with Grandma B. What a sweet face!

With Mommy

Walking with Grandpa B.

Naptime - Morgan and her Mommy

Wordless Wednesday: Morgan reads her book from Auntie Ali

Here We Go Again...

... another round of doctors and tests. I had my appointment with Dr. Scott F. Dye this morning. I tried really hard not to have any expectations about him or what he may have to say. I was anxious to possibly hear something new, nervous that I would be treated poorly, but I was also tired of the whole process in general. I brought my old X-rays and MRI films and my surgery report from Dr. Anderson and filled out the usual new patient paperwork.

Dr. Dye walked in and shook my hand like a businessman. For a second I felt like I was with the "rock star" of knee doctors, but pushed that thought aside still feeling nervous whether he would care much about my ongoing knee pain. Dr. Dye started right into the questions about my knee and was quite formal but straightforward. No wasting time here! One of the first questions he asked was how I found him. I told him I read about his research in Runner's World and the information from Mr. Ingraham in Canada where more of his research was noted. Dr. Dye just nodded his head and kept on with his questions. He seemed especially concerned about my comments involving the burning sensation in my knee and that my knee has never felt normal since the day back in March 2006 when the pain started. He performed the typical tests bending my knees, manipulating my bad knee and my good knee, all along asking if what he was doing caused me pain or not. He mentioned that my left knee had the typical swelling of an inflamed synovium, and that my right knee did not.

Dr. Dye then left the room, "to take some notes" he said, and I changed from my athletic shorts back into my work clothes. He came back 5-10 minutes later with my MRI films and told me our next step was to get a current run of imaging done. He asked me to set up appointments for a new MRI, a bone scan, and a special type of X-ray called a Rosenberg. Up until this point, I have not had a bone scan or Rosenberg X-ray. Dr. Dye put my old MRI films from before my knee scope up on the light box and pointed out how they showed an unusual amount of fluid built up around my left knee cap. Usually there is just a thin white line surrounding the dark kneecap, but in my film there is a much larger area of white. Dr. Anderson didn't mention this and wasn't overly worried about anything in my MRI other than the fact she was concerned about my knee pain. Dr. Dye explained that based on the old MRI he felt it I have a case of Patellofemoral Syndrome where the synovial lining is inflamed. In his opinion, the synovial lining is what causes the pain and burning sensation. Dr. Dye would know, he had his own knee scoped without anesthesia to discover this problem. Like I've mentioned in a recent posting... OUCH.

Dr. Dye then asked me about my physical therapy after surgery last year. He was really upset when I told him they had me doing things like lunges and leg presses. He said he never has his patients do things like lunges since they are among the exercises that trigger knee pain and hinder recovery. The last thing he did during my appointment was hand me some medical papers on Patellofemoral Syndrome (although he commented that it seemed like I had been doing my homework already) then said to me, "Let's get these new images done and see what we can do to help you." He gave me a small smile, shook my hand, and walked out of the room.

I didn't ask Dr. Dye about prognosis and recovery because I knew he couldn't say or do anything more until he has seen the new images of my knee. I'm going to try to set up those appointments for next week and then make a return appointment with Dr. Dye. Maybe within the next month I'll have a new plan for recovery. I figure it could go a few ways: 1) Dr. Dye will not see anything he can do surgically. That said, my guess is that he will have a better physical therapy plan for me that manages my "envelope of function" better and will get me on a real road to increasing that envelope. 2) Or Dr. Dye will see something he can do surgically, such as a synovectomy, and will advise to move forward with another scope. We'll see what happens.

Hmm... I'm wishing I had decided to contribute more money to my flexible spending account. Oh well. Here we go again.

A New Doctor

I made an appointment for next week with Dr. Scott F. Dye. I have been reading about his research over the past year and was reminded of him while reading the tutorial I purchased recently by Paul Ingraham. I thought, "Why am I not seeing this doctor? He is based in San Francisco!" I have mixed feelings about setting up this appointment though. On one hand, I'm not ready to give up on the health of my knee. I feel like I need to keep trying to find someone who will eventually be able to help me. There HAS to be something that can be done other than rest, minimal activity, and yet more physical therapy. Those things haven't worked for me so far, even my knee scope didn't help. Dr. Scott F. Dye seems to be one of the few doctors doing research on these annoying knee syndromes. He even probed his own knee to discover the real pain centers of his knee! Ouch! That's commitment to his trade. I'm hoping he can offer me some advice and alternate remedies I may not have considered yet. 

On the other hand, I'm scared. I'm afraid that Dr. Dye will look at me and say, "What do you want from me?" I'm terrified I'll receive a response to my plight similar as several other doctors in the past. They spoke to me with condescending tones and lectures indicating "you simply need to rest, you were doing too much." Ugh. I tried that, it's been 2.5 years of that. 

Either way, I need to be realistic that after all this time there is most likely no immediate cure or therapy for me and I will need to continue to deal with my cycle of trying to exercise, then my knee flares up and I'm back to rest. It's so frustrating! Still, I'm going to keep trying.

The Impossible

I don't like the word impossible, I really don't. It's so final, so complete. But, even though I hesitate to use the word here, it may apply. I mentioned in my July 28 blog that there was another thing I learned from reading Paul Ingraham's tutorial on Patellofemoral Pain Syndrome. Paul writes about a fictional woman he calls "Jan." Jan has suffered from PFPS for some time and she is Paul's character he created to describe how someone may finally recover from the ongoing symptoms of PFPS. First, Paul says Jan needs to spend a month or two figuring out what her knee can handle and what it cannot. This involves keeping careful track of what activities cause no pain (0), minor/pain delayed by 3+ hours (1), moderate pain/pain delayed less than 3 hours (2), and immediate pain (3) . After this has been documented, the next big step is to rest. Jan takes a month off of work for nearly total rest of her knees: every single item on her list is verboten for 4 weeks. Also, she cannot sit with her knees bent at any angle greater than 20 degrees. Her husband and family do the cooking and driving. She is allowed 1 hour of walking a day, but in 6 short 10 minute increments. 

I realize nothing is really impossible if you want something badly enough. Thing is, I am not able to take a month off of work to lie on my couch and I don't have a husband to help me with things around my house. Sure, I suppose my parents would probably try to help... still, it just seems so hard. The point is nearly total rest to the knee and joint. Paul feels like in some chronic cases, this is what is required to finally get past the see-saw of going outside of that envelope of function of the knee, flaring it up again, then having to go back to the drawing board. 

After the month of rest, Jan is to start back to the minimal activities that do not bother her knee, then over time the hope is to be able to slowly work her way to more activity and increase that envelope of function to a full recovery. I'm sure this type of recovery is a different experience for each person depending on the injury. 

Can I do it, you ask? I don't know. I really don't know. 

Worth a Try

So, I'm sure you are wondering, what have I already begun to try based on the article from Mr. Ingraham? It's rather simple in my opinion, but something that had not crossed my mind at all while trying to recover from Patellofemoral Pain Syndrome (or whatever other overuse syndrome that may be causing my knee discomfort). Mr. Ingraham states that even bending your legs at a 90 degree angle while sitting at your desk at work puts "load" on your knees. Interesting. He suggests placing a box under your desk and putting your feet up on that box so your knees are around a 20 degree angle (not straight, since locking your knees isn't good either) can help lessen the pressure between your patella and the joint of the knee. Well, hey... I figure anything is worth a try at this point!

If you haven't noticed, Paul Ingraham placed a comment on my blog in the July 28 post. That was very nice of him! If any of you reading my blog are experiencing any of the common overuse syndrome type injuries (PFPS, IT Band Syndrome, Plantar Faciitis, etc.), you should give one of Paul's tutorials a read.

I recommend Paul Ingraham’s patellofemoral pain syndrome tutorial.

If the link in this post does not work, try to access the information in the "Links" section of my blog.

Wordless Wednesday: I Love This City