The hopes were high after two months of no excessive fluid build up in my right knee. The first injection in September only lasted one month. The second injection went in October 4. Continue reading “And in goes Cortisone nr3 ….. – Rodric Leerling”
Tag: knee injury
This week, another much anticipated hospital appointment took place. It was to become a new discomforting medical talk.
It all started with good news. The rheumatologist told me no real abnormalities were found in either bloodtest or new x-ray photos. More importantly, no crystals whatsoever were found in the excessive knee fluids het extracted last time. Meaning, it is almost certainly not gout or ‘pseudo-gout’ (chondrocalcinosis). The bad news was slowly building up in my mind. And made written notes this time to remember the test results in more detail.
The specialist suggested one more fluid extraction from my swollen knee and wile the needle was still in, inject it with double the volume of corticosteroid in order to try once again kill the stubborn inflammation. I agreed as this seemed the last effort to cure the 15 weeks knee misery. In two weeks time, a 3rd extraction (if anything left) will take place for a final check on pseudo-gout. And another blood test.
I had to ask the question: so doc, what’s next if all this doesn’t work out? Well, if it’s definitely no gout (and that’s already for 99% certain), we are entering the early indication of the rheuma realm. A new therapy will need to be started and another medication to stop the inflammation. Probably back to a prednisolon course.
The injection was less comfortable than the previous extraction. The medication was added and I was instructed to keep calm for 2 days and then slowly try to exercise. In the meantime, I keep my fingers crossed.
Today, I visited the student orthopedist again in hospital. His injection of three weeks ago didn’t have the expected effect. I enjoyed a short three days of a non-swollen knee. Since ten days it’s back and hence limping time again. And that for ten weeks on a row now.
I called and asked the hospital reception last week if I could just have a phone call to tell the doctor that the injection didn’t work for long. No, I was told, you have to come in person and see the doctor again (hence the expression ‘pay them a visit’?).
It was the usual 30 minutes delay and then within 2 minutes the conclusion: “hmmm, this is not good, I have to consult the specialist. I will be back soon.” They basically ticked the same boxes as my GP had done four weeks ago. The verdict: an MRI scan to check the tissues around the knee. See if there is something wrong that couldn’t be spotted on the X-Ray. Another injection was not possible, unfortunately.
To my big surprise, the scan could be scheduled on next Saturday with the follow-up consulting visit on Tuesday. If that’s not going to produce any clarity, a tube operation will be the last resort.
I think I’m going to call the Dutch football association telling them that I’m not going to be ready for the season opening games. In the higher ref league. Four weeks to get back in shape is basically too little time.
Finally, after almost eight weeks of taking different meds, seeing three doctors, and having an X-ray taken, it was time to visit the orthopedist in hospital. The medical degree candidate did the take-in. He read the files, studied the X-ray and, of course, wanted to examine my knee. He showed me the X-ray images and, in contrary to what my GP had diagnosed, there are no loose cartilage parts visible at all. What the X-ray picture did show was basic wearing out of the knee. And an operation won’t help in this situation. My roller-coaster cart was about to run down fast.
The student had to confer with the orthopedist next door and left with my panicky thoughts for 25 minutes. So, no operation. What does that mean? Is the wearing out really bad news and should I abondon all sports, including refereeing? How will the swelling be reduced now and will I ever be able to use my leg properly again?
The medical candidate returned and confirmed an operate was off and might even cause more physical trouble. But, he had another solution. The meds I haven been taking were processed by the whole body (like Prednisolon) and work but only for a short term (don’t mention the side-effects). He advised an injection directly in the knee. This fluid med called Corticosteroids would need two weeks to take effect. Most patients with my medical condition have benefited from it. I would be able to charge the knee again soon and back in shape in six weeks. My rollercoaster cart was going north again.
If I wanted the injection now? Sure, bring it on/in! The needle was set quickly and the meds were brought in. Two weeks max to reduce the swelling to zero. Four weeks to build up muscle tension. I wasted a few weeks in the Dutch 1st line of care, luckily just off-season. My roller coaster cart has arrived in base station. Time to start working a swift recovery.
After weeks of taking different meds to kill the sudden burst of pain and reduce my knee swelling, the first diagnosis by my GP has been drawn. There are fractions of cartilage around the knee that should be ‘cleaned up’.
Why and how this ‘cartilage delivery’ works is not clear, but the X-ray results showed it clearly. The loose fractions around the knee are causing the body to react and produce moisture to encapsulate the danger. An orthopedist has been asked to examine me further and probably come up with a surgery proposal to do a ‘clean up’.
I can’t wait as this has been dragging on now for seven weeks already. The moisture in my knee prevented the GP to track the cause of the pain and swelling, as it basically formed a medical ‘cover-up’. Only after weeks of meds and eventually a reduced swollen knee, the injury could be diagnosed and the X-ray picture requested.
So much for the Dutch medical ‘1st line care’: patients should be seeing their GP as much as possible ‘in the 1st line’ and only when really necessary visit a specialist in hospital, called the ‘2nd line care’. This is believed to lead to a reduction in medical costs. But in my case, this has so far lead to 8 weeks of limping, a painful and swollen knee, 4 GP visits and 3 different medications, before finally an X-ray was requested and steps to surgery taken. Who knows how long this ‘2nd line of doctoring’ again will take. Keep you posted.