August 2014

Patient Perspective: The long struggle to get a knee back in the game

9_FA_patient_perspBy Joseph Hayward

It happened about two years ago while I was playing a friendly game of basketball with my teenage sons and friends. I was 49 years old and never felt like slowing down. Like most guys, while playing ball, we would imitate our favorite players. I tried making a LeBron James lateral fadeaway shot when I felt something in my left knee. At the time it seemed like a sprain. I was able to continue playing, but transferred most of my weight to my right leg. When that game ended, I wasn’t up for continuing to imitate my favorite NBA star.

This happened on a Sunday afternoon. While watching TV I decided to ice my knee, as it had appeared to swell a little. Monday came and, as I went to work, I experienced a slight pain in my knee. I felt at the time that I could tolerate the pain and didn’t need to see a doctor. I had served in the military for 20 years, and in my experience military medicine involved giving the patient Motrin or some other form of pain pill and sending them back to duty. That was why initially I didn’t seek medical attention.

However, my job as a college admissions representative requires that I escort potential students around the campus. It is a busy campus and the property is about a block long and three levels up. I was on my feet quite often. I walked with a slight limp for about two months, but then the pain seemed to go away.

The pain returns

Summertime came and the warm weather was perfect for my other sporting pastime—football. As a family we would go to the park and take walks, throw the football, and have a snack. Again, part of the fun was role-playing, only this time it was a position—wide receiver for the Miami Dolphins. But when I went out for a pass, the leg pain returned. The pain was sharp, and I wasn’t able to put much weight on the leg. There went the end of my football season. As the summer continued, we would still go to the park, but I would remind my sons about my leg and my limits.

Rather than trying to tough it out, I took ibuprofen and decided to purchase a knee brace for support. The first one was bulky and had straps to tie it down. I continued my routine at work with the brace, and it did provide some comfort. At times it would slide down my leg, so I would have to make adjustments throughout my day. But I really wanted to get back to a regular running routine and to get into better shape. I decided to join a boot camp at my local YMCA. I signed up for not one, but two classes. They were on Tuesday and Saturday mornings, for six weeks. Both classes required a physical assessment prior to enrollment. A timed run was the first event for both, and I ground it out, in spite of the pain, to pass.

Once I got past the assessments I thought it would be easier. I was wrong. The first week went OK, although the knee pain started getting worse. By the second week it felt as if the bones in my knee were rubbing against each other. I got a second knee brace that was a slip-on one-piece designed for sports.

The instructor for the Tuesday class incorporated more cardio and running events than the instructor for the Saturday class. I finally threw in the towel when we had to do a group run. I don’t remember the name of the drill, but the group runs in a single-file line and the last person has to sprint to the front. The run continues for about a mile until everyone has completed a sprint. The honors were mine to start as I was last in line. That was my last day of boot camp.

Seeking medical attention

Finally, at my wife’s urging, after about nine months of limping around, I went to see our family doctor. The doctor ordered an x-ray, told me I had arthritis, and sent me on my way with a prescription for a high-powered anti-inflammatory. Here we go again, I thought, not much difference from the military—and I could have purchased additional pain relievers on my own without taking time off from work. The diagnosis just didn’t seem right, and I refused to believe that I had arthritis. I thought about my family’s medical history and I couldn’t recall anyone with a case of arthritis. My grandfather had been active until he passed at the age of 95 years. So I went with the diagnosis initially, but was not sold on it and continued to work out. My thought was that, if my knee got stronger, it might help alleviate the pain.

A knee injury during a friendly family basketball game ended up sidelining the author for nearly two years.

A knee injury during a friendly family basketball game ended up sidelining the author for nearly two years.

Finally, an MRI

In November 2013, I went back to the same doctor and insisted that he check for other ailments. He ordered an MRI (magnetic resonance imaging), which showed a tear in my meniscus. I was excited to finally have a diagnosis that made sense. Now it was a matter of getting a surgical consult and insurance approvals.

The surgeon I met with assured me this would be a simple procedure. He talked about the procedure and rehab. The surgery would have been between Christmas and Valentine’s Day, so I postponed scheduling the surgery until the December holidays were over. Then, the referral had expired, and I had to get a referral for a new consult. Before that consult, a family member died during a surgical procedure. I was now nervous about the surgery. But the surgeon made me feel better. We talked about my family member, and I realized she had other medical issues that had contributed to her passing.

The author’s copper-infused knee sleeve.

The author’s copper-infused knee sleeve.

Day of the surgery

I arrived at the hospital at 6 am to check in for my left knee arthroscopy with partial medial meniscectomy and chondroplasty. During preop the physician assistant (PA) estimated the surgery would last about 45 minutes. My wife reported later that I was in surgery for only about 20 minutes. The surgeon met with her briefly after the procedure to let her know that everything went well. He said that at the two-week follow-up appointment they might or might not refer me to physical therapy. The nurses in the recovery room were very thorough about describing ban­dage and wound care and reviewing my pain medications. I would also need to take a baby aspirin to avoid clotting for two weeks.

I was instructed to do partial weight bearing on my left leg for the first day, then full weight bearing the next day. I was extremely nervous about this and requested crutches to take home. Otherwise, I was going to have to get out of the car at home and walk up an inclined driveway while partial weight bearing with no other support. It would have been helpful to have worked out these logistics prior to the surgery.

Home at last

We live in a two-story house, so I had planned to sleep downstairs. The boys moved a mattress downstairs onto the floor for me. With the remote and some comfy pillows, I was set. Getting on the mattress was easy, but getting up wasn’t. Using the bathroom on my own was like going through the “American Ninja” course.

On day two, while using my crutches, I started to move around the house. By the fourth day I was able to go to the grocery store. One mistake I made was continuing to take the pain medicine when I probably didn’t need it. Even though the prescription bottle said “take as needed,” I somehow got the message that I would need to continue taking it like clockwork until it was gone. After my first week home, my wife asked me how my pain was without the meds. I replied that since I was continuing to take the meds, I wasn’t having any pain. She suggested trying to skip a dose to see what my actual pain level was, and it turned out that at that point I really didn’t need it any more.

When I went to my two-week follow-up appointment with the PA at my surgeon’s office, I still had a slight limp. My range of motion at that point included full extension and about 40° to 45° of flexion. The PA said I could do exercises on my own to improve my strength and range of motion. I requested a referral for physical therapy since I was feeling weak and not confident in my knee. I did order a copper-infused compression knee sleeve online, which was great. It seemed as though energy was flowing through it. I was able to bend my knee and walk without a limp while wearing it.

Back in the game

Now I’m 51, and it has been almost two years since my initial injury. Once I returned to my regular work schedule it became difficult to schedule regular appointments for physical therapy. I feel like I missed a window of opportunity following my surgery when I had the gift of time to follow through with therapy. In the end I did my own exercises, bike riding, and stretching. I currently have full range of motion in my knee, and the pain I experienced before the surgery has, for the most part, disappeared. I’ve jumped into a few basketball games with the boys and thrown the football around, and have had some pain when making lateral moves. I continue to wear the copper compression sleeve for support. My running shoes still look brand new, but I hope to break them in soon.

Joseph Hayward lives with his wife and three sons in Puyallup, WA. He works as an admissions representative for a career technical college.

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