Whenever the rainbow appears in the clouds, I will see it and remember the everlasting covenant between God and all living creatures of every kind on the earth." Genesis 9:13

Friday, March 12, 2010

Child abuse sucks

I have no more appropriate title. Today was really, really tough.

About a month ago I wrote about my occasional issue with tolerating pain too well. At that point I blamed in on anti-psychotics as I have seen this with my own patients and my dentist also mentioned noticing it.

Well, today a whole industrial sized can of worms opened up. Everywhere. I'll be chasing them for a while I imagine.

I had my follow-up at the podiatrist today. When I made the appointment for the first visit last week I felt sure that I was overreacting to my sore foot (injured soft tissue from how I have been holding my weight while my ankle healed). But I can't take anti-inflammatories and every OTC insole and support I had tried did not help. So I figured I'd go and leave with a recommendation for different insoles.

Instead the doctor focused on my ankle injuries. He was very thorough with both sides, but the ankle got a lot of attention. He told me that if I didn't have the brace I have he'd have sent me out in one of them. He took a ton of X-rays of that ankle and foot and only a few of the foot I had come in for. He taped that foot, said if it worked a pre-fab orthotic would help, and that I should come back today for follow-up and x-ray results if they showed anything. He seemed suspicious that there would be a healing fracture of one of the bones in my foot, which I'd had symptoms of but was treated the same as if I'd had it anyway so it was never pursued.

When I got there today they said something about "he'll give you your x-ray results" and so I thought "huh,must have broken that meta-tarsal". He came in and put a film up. A film that shows quite clearly where I broke my ankle before. It's very healed; I didn't do it this winter. I know when I did it. When I was a sophomore in high school I fell twice during the same cross country meet. My ankle hurt afterward, but so did nearly everything else. And in my house there was no complaining of such things. My father had me totally convinced that I overreacted to all things medical. He told me it was fine and so I went back to cross country practice immediately. He wouldn't even buy an ace wrap until the coach pulled me from practice. Even then I was running the next day. I then proceeded to increase my running until 3 months later I was running up to 10 miles per day, 5-7 days per week. Which was when I fell and destroyed my knee.

Nobody ever could explain how I managed to do such a thorough job of tearing up my knee in just a fall from tripping over a curb. I did land hard, and there were some mitigating factors in there, like the dr. who said "girls shouldn't do sports" and left me with torn cartilage that I then proceeded to tear very badly a few months later in marching band while executing a tight turn. Even then that doctor insisted nothing was wrong and ordered a test my insurance refused to pay for, insisting on a much more expensive (and still rather new) MRI instead because of the degree of pain associated with the outdated test. That ultimately led to the removal of my cartilage, and then after months of doing pre-season with the boys' track team to recover my strength I started track and one of my hamstring tendons (which had acted weirdly all along but hadn't really bothered me much) began locking and making weirdly audible across the room snapping noises (it had done this intermittently but now it was always) as it wrapped around and around itself. This was an injury nobody had seen before, and so the surgery for it was rather involved as the dr. went in with no real idea what was the solution or how the problem had happened. The chief of orthopedics at this big hospital was in the room observing as were many residents and med students. I was actually awake for a good part of it so that I could kick on command so they could see what was wrong. When it became painful even with numbing I was put to sleep, but was awakened before they closed to kick again, although that part I don't remember. The surgeon actually was able to opt to do little, making recovery easier. There was no saving the tendon or reattaching it in a better place as he'd planned (hoped). So he cut it and let it just retract and scar into place. I wound up ultimately with 1 hamstring tendon gone, one mainly covered in scar tissue, and the 3rd fully functional. So essentially the only thing to do was to strengthen the quadriceps muscles the best I could, and 6 months later he told me I could run again or do anything I wanted except for roller or ice skating due to the high risk of falling on a knee that had no cartilage. (To illustrate how much cartilage was removed, while recovering from the tendon surgery I tore the fragile new scar tissue that holds my leg together and fell down some stairs. The leg swelled and turned bluish. The doctor saw me emergently and said that if I had any cartilage he'd go in suspecting it was torn but there wasn't any to tear so it had to be the scar tissue, use the brace and crutches for a few days and go slower on the stairs next time). He also told me that it would hurt and that repetitive movements were likely to give me repeated tendonitis, so I might want to find alternative sports although he wasn't going to restrict me. I tried running for a while but it did hurt and while I made it through my senior cross country season as an active athlete except when it was muddy and the coach wouldn't let me run or on one particularly hilly course, I gave up running not terribly long after. I learned about the tendonitis thing the next fall when I had to take a swimming test for gym class in college and wound up on crutches for a couple months.

I've had to adjust many things around that stupid knee over the years. I don't use normal body mechanics. Mainly I've relied on my ankle and hip to stabilize that leg and I lift partly with my back and a lot with my arms and other knee. Since I hurt my ankle I've had to learn to lift differently again.

Anyway, back to the present. From the time this sprain happened there have been questions about previous sprains because of ligament laxity. I remembered the "twist" in cross country and another minor sprain about 5 years ago, plus the twisted ankle in Nov. on that side. I don't remember any of these as particularly painful. Yet the proof is clear: I broke my ankle and it had to have hurt, yet I kept running on it, right up until the not-close-to-healed fracture caused me to fall and destroy my knee. I got that confirmed today as the likely story.

As soon as that X-ray went up and I saw that healed fracture (it was quite obvious) I realized exactly what has happened. I don't have a high pain tolerance from meds. I have a high ability to ignore pain because to do so was the only way to survive in my home. I was yelled at and probably worse and called a hypochondriac for so many years as a child that I had to have someone pretty much teach me against my will when to call a doctor when I was an adult. For years I would only call if prodded repeatedly, even if it was something like my new AD was making me vomit and not eat and I'd lost 20 lbs in a few weeks. Since starting with Dr. Body I've developed a comfort level and will see him and be honest about how I feel/what I need, but that's a pretty new skill for me.

Therefore, during the worst years of the abuse, there is no way I would have complained. When my knee was at its worst, before the 2nd surgery, the coach actually had to pretty much physically stop me from running stairs and then tell me I wasn't allowed to even come to practice until cleared by a doctor, and that if I was seen running anywhere I'd be done. I was too afraid to tell my parents (father) how much it hurt. After my second surgery, which was a fairly long procedure with a lot of poking around trying to find solutions, and a very deep, several inch long incision the doctor wrote for a week off school. Surgery was Monday, i was in school Wednesday and off painkillers by thursday. At which point I nearly fainted and was kept home Friday, but i never took another percocet and never missed another day with it except for check-ups. Better that than to hear about how awful i was for complaining.

And so now I will pay the price. My sore foot will heal. It's got some biomechanical issues but they aren't that bad and my custom orthotics will fix it. I do have to get custom ones, which are quite expensive and not covered by insurance. I think that's more for the bad ankle, but the other foot needs support too. My bad ankle? Not so much. It has a lot of issues. Enough that I will have a custom orthotic in there too, which will be made to correct a number of issues. I also will be wearing my ankle brace not just for work, and not just until it is stronger (I was told it was to be worn long-term but wasn't planning to adhere to that), but forever and anytime I'll walk on any uneven surface. Meaning all the time I'm not at home. I got a new brace today because mine was already worn out. If I go through them that fast normally we're talking about $300/year just on those. A more permanent one would, I assume but need to ask, be too restrictive and just add to the weakness while this one lets me move pretty freely except for turning my ankle in or out. I have been reminded twice today that we've discussed surgery as a potential if/when I hurt my ankle again. I also will have some more specialized xrays and possibly an MRI at that point.

So, that's been quite a bit of knowledge to gain in one day. I am still processing the implications: basically because I was so afraid of my father that I was willing to ignore what had to have been considerable pain I am facing an entire messed up leg that didn't have to happen. My knee always was considered "one of those things" because without knowing I was running on a partially-healed fracture it was impossible to guess that as the root cause of the issues. Now I know that this was preventable if only someone had bothered to be a normal parent and treat a fractured ankle. What's more, I probably wouldn't have all the ankle problems. And since I'm now aware that both of these joints will likely be giving me problems for the rest of my life, I'm just a little angry. I already knew I would have 1-2 knee replacements on the left in my lifetime. Now it appears I may have ankle reconstruction too and since he keeps reminding of this I'm assuming it's something I should get used to.

I am so incredibly angry right now. I certainly grieved for the loss of things I loved, like running and swimming (which I taught myself to do without repetitively kicking through the bad knee eventually), and for a knee that made me not entirely "normal" for someone my age. But now I have to grieve both for the loss of a normal ankle and from the knowledge that the entire thing might have been prevented had it been safe to actually fall and break a bone in my house. And that's before we go into the implications of this kind of thing on my career. Because if my ankle becomes more unstable I'll be unable to lift patients which is really a big part of my day. From what I've read that would be the time for reconstructive surgery which would apparently be horrible but effective. But theoretically this ancient fracture with so many negative consequences might end my time doing what I do and force me to work in another practice area, which has it's own set of problems, as in thanks to how sick I was getting in grad school I didn't exactly absorb a ton and what I know I've learned on the job for the most part. I may be qualified in name, but I am not qualified in practice, to do other areas.

And after all this you didn't even get to hear about the scary, scary window man. Tomorrow.


Jean Grey said...

Think about making the shift to outpatient! While I really liked inpatient, I think I would someday get too old to do max assist transfers. So it is a better future for me to now be doing outpatient, and hands. I hope to be practicing for a long time!

Just Me said...

I think that's true for most therapists. I think if I had to leave I'd probably go into something related to mental health. That was about my favorite thing I've done anyway.

For now though I'm pretty bound to this contract job, because until we know how my ankle fully heals I need to stay there so I have FMLA if I do need surgery. Surgery would mean as much as 6 months off, so the coverage is important.

Anonymous said...

I hurt both of my ankels when I was in my 20's and doctors just kept telling me to keep skating after I hurt the first ankle. Well skating on a bad ankle caused me to hurt my good ankle. After two years of being told it was in my head and to get a job or see a psychiatrist I finally found a doctor who listened and I got major reconstructive surgery on both ankles. It worked well for years but now I need to have my right ankle looked at. It is too loose. Doctors tend to treat women with orthapedic injuries as if it was all in their head.

It makes it worse when child-hood abuse has taught us how to dissociate our pain. When I'm in the ER and they ask me to rate my pain on a scale of 1-10 I always rate it 2 higher than I actually feel so it will be more accurate.

When I broke my wrist it felt like a 6 so I said it was an 8.


Scream said...

It makes it worse when child-hood abuse has taught us how to dissociate our pain. When I'm in the ER and they ask me to rate my pain on a scale of 1-10 I always rate it 2 higher than I actually feel so it will be more accurate.

When I broke my wrist it felt like a 6 so I said it was an 8.