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

Monday, April 07, 2014

Fwd: Consistency, PLEASE?

I saw the ankle dr today.  She isn't a surgeon, she's a physiatrist (rehab specialist).  She had some listening issues.  She seemed to think I WANT surgery and was opposed to therapy.  I'm a freaking therapist, what does that imply to most people?  I have been told though that therapy will no longer help and that surgery is necessary if I want this repaired.  She disagreed with everything the dr. down here had ever said about anything.  Absolutely nothing was right.  And maybe he is wrong.  But I already failed therapy once.  A lot of her basis for argument was that I haven't had a bad injury in several years.  That has a lot to do with the fact that I am very good at wearing my brace when there is a risk of hurting my ankle and I'm also very good at ignoring lingering pain.  My ankle hurts a little all the time.  Sometimes it hurts more, sometimes less but I'm used to it hurting.  I probably didn't express that well, that I wouldn't notice the pain until it was quite bad, but when I did try to explain it she blew me off. 

She had never heard of the procedure that has been recommended.  She had to look it up and remained skeptical.  Yet it is the surgery of choice for people with my problem 

She also was just weird.  I have a bump on my heal that makes my achilles tendon quite sore much of the time.  I thought it was maybe a bone spur.  She said no, it was a nodule on the tendon.  But she has no treatment for it.  Um, thanks?  Another reason that surgery is currently my preference is that I want that thing removed too.  I can't see it getting less painful with time.

She did finally ask an orthopedist (after warning me she wouldn't refer me to anyone who will do surgery easily, again with the "you want surgery you don't need" thing (and if I don't need it that isn't because I decided I did, it is because my old doctor has repeatedly told me I did, right up to 3 weeks ago.)  He told her that some people opt for surgery rather than living with the constant turned ankles, sprains (mild though they might be), pain, etc. but that he wanted to see me to make sure I understand how intense the recovery is.  That's fine with me.

So I agreed to try PT. I'll start that tomorrow.  I'm hoping to have limited visits b/c of the cost.  In 3 weeks I see the ortho.  Regardless of what he thinks I don't know if he can do the surgery as it looks like he only is at this one clinic I visited today and if that's the only place he does surgery it won't work as it is outpatient surgery only which I can't do because then I have to pay for 20% of my surgery and because with the MAOI I need monitoring post-op.  And from what I've read this can be a few days hospitalization anyway.  So I have to find out if he has hospital priveleges and if he does and they aren't at the main campus if Dr. Brain is still comfortable with that (since she has to coordinate the anesthesia protocol and having psych involved and she usually comes to check on me herself).  I'm not sure what happens if she isn't.  I guess I try for another referral. 

This doctor was nice enough, she just wasn't picking up what I was saying.  She was very over-confident.  She's only been a doctor for about 18 months and I think inexperience was rearing its head today.  She also didn't know basics, like where the guy she referred me to has surgical privileges.

Maybe PT will take care of everything.   I admit that my last round of PT jaded me because they were AWFUL.  I know that isn't true always and that it may help a great deal.  But I don't think it has the power to repair the torn ligaments permanently and I can't be in PT all the time.  It also doesn't get things so that I can walk without a brace, do anything I want to do without risking re-injury, wear whatever shoes I want, etc.  And it's not like I take surgery lightly; I have good reason to be quite wary of it.  But the bottom line is that I want this to be fixed.  Permanently.

Otherwise still needing lots of anxiety meds and still crying a lot.  A song I forgot was on my ipod came on just as I got off the exit ramp for home this evening and I sobbed and cried the whole way home and then some.  I did get 4 hours of sleep last night (5?) which is much better.  But it took a lot of medication  achieve that.

Just 2 days until I can talk to Dr. Mind.  And talk and talk and talk.  This is so hard because when we talk about it we all wind up crying, or things are said with the wrong meaning.  We are fumbling around in the dark and not finding much that makes sense in either our interactions or our own emotions.  All of us need meds to sleep right now.  Which is weird because it is exhausting to go through a day thinking about everything that is on our minds.

It just makes no sense.  Life, that is.  And maybe I could've handled the dr better if I weren't so tired and stressed and sad but that is how I feel and I can't change that (and wouldn't because feeling otherwise in this situation would be pretty unhealthy.)


Jean Grey said...

If you find physical therapy to be useful, please let me know! I have a bad ankle- not as bad as yours- I had a bad sprain playing tennis in high school and back then they just shoved crutches at you if it was not broken and said stay off it for a while. Now I would have had physical therapy, and maybe even an MRI. I know I have torn ligaments, because when I walk more than a couple of miles my foot starts tunring in. If I walk even more it really starts to hurt and swell, as though I have re-sprained it.Then I have to go into a brace for a couple of days. Not fun. I know I need some proprioceptive retraining, as well as strengthening the right muscles to do what the ligaments can no longer do. There are some neat things you ca do with kinesio tape to support ankles and increase proprioceptive cues. I need to look into that. Maybe, after I finish up PT for my back, I can go for my ankle! I know that both the back and the ankle are going to require exercises that I do pretty regularly for the rest of my life. Exercise can strengthen muscle, as you say it cannot fix a torn or lax tendon.

Just Me Jen said...

The ignore sprains approach led to this. It was broken but they didn't realize that and if I'd complained I would have gotten crutches and some taping from the school trainer/town chiropractor. I didn't want that so I kept my mouth shut.

Have you tried a lace-up compression brace? They have strapping that mimics taping and might help if you wore it when you started walking long distances/hiking. I can give you a link if you don't know what I"m talking about. They are also pretty cheap. http://www.betterbraces.com/procare-stabilized-ankle-support

Today I got some theraband exercises (black...after treating only elderly patients so long and green being the heaviest color used most of the time I feel all superwoman like) and stretching. I am lacking some dorsiflexion bilaterally as well as the instability. That much we probably can fix. The PT did not say much about outcomes for that; we kind of agreed that we'd do what we can and know that the ligaments are damaged and that I am tired of problems and will probably be doing surgery.

My proprioception is AWFUL. I fall fairly frequently because of it (almost fell on the way to the dr in fact). When we were doing a proprioception test in a training when I was working they demonstrated on me and everyone found it really funny.

I did find it telling that while I do have some exercises for the ankle it is more about fixing the dorsiflexion than a lot of ankle stuff.

I also learned that I cannot stand on my bad leg unsupported for more than 3-5 seconds.

I used kinesiotaping on my feet several months after the bad injury because I got plantar fascitis from limping and not having arch support in the cam walker. It really helped a great deal once I got good at doing it on myself. (Oh, that's another thing the dr yesterday did that seemed weird; she wants me to buy OTC inserts. I have custom-made posted orthotics. I will not be spending more money on less supportive orthotics....Duh.

We'll know in a few weeks what this does. I go back Thursday....

Just Me Jen

Jean Grey said...

I might try some bracing in the future. What I really want is to strengthen my ankles enough that I don't have to, if that is possible. It won't fix the ligament, but I figure that if the muscles are stronger the ligaments won't have to do so much work. I do know that I have gotten better at standing on my right leg through yoga- but it still isn't great and still isn't as good as the other leg.