Author: Jen Rios

I started back to physical therapy on February 23rd after Dr. Frush extended my prescription again and, this time, it was approved.  Each night after physical therapy, I start the draft for a blog post to talk about it. I have yet to post ANY thing from my time at ATI.   The fact that I am so behind in posting bothers me. I couldn’t figure out why I was not taking the time to write and post. Writing blog posts has been great for me for over two years.  It was only yesterday that it really dawned on me. I am depressed.

I’m depressed because I have  been in pain for six months and six days. It’s the kind of pain you feel in your teeth and your eyes.  It’s a pain in your fingertips that you can’t even clinch into fists because that is too painful.  Rather you just open your hands and feel the pain surging through your fingers all the way to your fingernails.   I have in this pain from the second I wake up to the second I go to sleep.

I’ve lost count of how many times my knee has popped out, around 23. It goes to the left and also it has popped out to the front. My Mom has always just popped it back in  so my new colleague, Mr. Langford, says that she is “Hard-core.”  It has popped out multiple times every day for the past week. My son has now witnessed it popping out and he also has had to be “Hard-core” and the one to pop it back in.

My knee feels absolutely wonderful and ATI,  Luba and Brad work with me.  They use the ultrasound machine and manual traction as well as Kinesio tape.  It feels absolutely great but then I leave physical therapy and my knee goes right back to hurting. Because it has hurt for so long, I can pinpoint where it hurts. It hurts on the inside  which is my MCL that I remember seeing the MRI scan and it is torn. It hurts on the outside of my knee where all the cartilage damage was that I also saw and the MRI scan.   Dr. Frush had explained both of these things to me before but now the only time it doesn’t really hurt is when my knee is in traction, when Brad “Opens the joint.”

I’ve thought about this a lot and the fact that it hurts in three different places, a few people have thrown out the suggestion of me needing a total knee replacement.   My aunt had double knee replacements 17 years ago and I remember the excruciating pain she was in! Add that to the fact that I have Multiple Sclerosis; I can’t even think about the time it would take for me to heal from this and how exactly I would rehab this.

This scares me because I know that knee surgery hurts more than having a child (or at least my C-section experience of having a child) and I didn’t have MS the last time I had knee surgery.  I just can’t stand the pain any longer. So I guess six months and six days is my limit. I look forward to tomorrow when I see Dr. Frush and he can tell me what we should do.  All I know is that I just can’t stand being in pain like this anymore.

Well,  my knee has NOT stopped hurting since September 21st and after my January 5th appointment with Dr. Frush, my knee began popping out of its socket.  It has popped out from January 6th to February 15th eight times.  That doesn’t sound like a lot, but each of those eight times has been excruciating! It makes a popping noise when it comes out and another popping noise as it has to be put back into place. This fact has  concerned me greatly!

My friend Renée took me to Dr. Frush’s office and came back into the exam room with me.   The nurse case manager had arrived to Dr. Frush’s office and explained to me that my physical therapy had been approved but only twice a week for six weeks.   I REALLY liked going to therapy three times a week.

I had called Dr. Frush’s office the week before and told  one of his assistants about my knee popping out.  So he knew about it before he came into the room.  He sat next to me and we talked for a while before he examined my knee. He had his “thinking face” on.   He asked me specifics of my knee popping out and clarified the fact that I have not been to physical therapy since December 1st.

 Then the examination  began.  He pressed on my knee and it still hurt everywhere he pressed. I asked him about my “Mount Kilimanjaro” and he told me that it is called the “Hoffa’s pad” and that I do not need to worry about it. I researched “Hoffa’s pad”online to spell it right, first of all, but also to get some more information about it.

Apparently, it is actually called the Hoffa’s fat pad.”  The peak happens when there has been knee trauma or surgery which I have had both. It happens with the shortening of the patellar tendon  from the trauma or surgery. He told me it was  just the “Hoffa’s pad.” So it was good form that he didn’t tell me that  my knee was “fat.”

 Then he held my knee with his left hand and pulled it to the left with his right hand. That hurt a whole lot more! Then he switched hands and pushed my leg to the right.  Instead of just saying, “yes” when it hurt, I grabbed the arms of my wheelchair and gasped.   My reaction kind of concerned me almost as much as his look of concern.

 He told me that he  wanted to hold off on surgery because I had not done all of the possible and necessary non-surgical remedies.   Two extensions of my physical therapy have been denied.  He told me that he was going to prescribe one more round and see how my knee is doing the next time I see him.

 Then, the nurse case manager went in to talk to him as I went to the front desk to see about my discharge papers. As I was arranging my return visit,  she came up and met me at the front desk.   She told me that I should go to therapy three times a week for four weeks and she will work on getting the two more weeks approved. She told me that Dr. Frush told her that if my knee is not doing better at my next appointment, he is going to  go in with a scope. She then told me that paying for two weeks of therapy is a lot cheaper than a scope!

My school was still on Christmas break when I went back to see Dr, Frush.  The nurse case manager who usually accompanies me was not able to attend so there was another woman who came in her place.  I went back to the  examining room with my mother and we met with Dr. Frush’s resident first.  I unsnapped my pants and he poked around on  my knee and it still hurt everywhere he poked.  I told him about the discontinuation of my physical therapy.  He looked a bit surprised and then left to get Dr. Frush.

Dr. Frush came in and also poked around on my knee and it hurt everywhere he poked as well.  He  also looked surprised when I told him that my physical therapy was discontinued.  He asked what their reasoning was and I told him that they said it was “Not medically necessary.”  He immediately turned to his resident and told him to write in my notes to set up a “Peer-to-peer.”  I didn’t know what that meant but I know that he looked like he meant business!  He told me that physical therapy IS medically necessary because my knee looked WORSE than it did the first time I saw him.

He wrote another extension for physical therapy and told me that I can not rehab normally.  Yay MS! Right?!  Dr. Frush  left and the nurse case manager was called in.  When she came into the examining room, we waited a little while until Dr. Frush  reappeared.  He explained to this woman that I have a “nonsurgical injury”  and he wants to set up a “peer to peer” with the examining physician from the company.

It was here when I figured out what a “peer to peer” meant.   My doctor wanted to talk to the Doctor who examined me from the company to get my injury straight.  My doctor, Dr. Frush, understands that the physical therapy Is necessary. So two doctors are going to get together and talk about my knee.   I was excited that I would start physical therapy again!

I am writing this blog post on February 8, 2017 and I have not been back to physical therapy yet.  My knee has not stopped hurting! I go to sleep with it hurting and I wake up with it hurting. It hurts all day and sometimes wakes me up throughout the night. I desperately want all of this to be over!   I see Dr. Frush again on February 16, 2017 so we will see what he says then…

I went back to work that Monday, December 5th. It was a rough day. For many different reasons! I was able to ice my knee and that was a fiasco in and of itself.  I could feel my leg throbbing more because I was doing a lot more than just sitting at home.  I looked forward to going to physical therapy and getting my knee worked on, I swore it was swelling by the minute!

I can’t tell you where exactlyI was when I got Luba’s call (but I know that I was in public) but I remember the feeling after receiving it.  I felt the sting in my eyes and nose as I tried to hold back tears after I hung up the phone.  I had that hollow in my throat as if I’d just been punched in the stomach.   The responsible party was no longer paying for my physical therapy.  They hadn’t paid for my last seven visits.

I told her that I had Dr. Frush’s prescription for extended physical therapy but Luba told me not to come to ATI until this gets straightened out.  She wasn’t sure if it was my fight or theirs to get this paid for.  She was going to get answers and get back to me.  I was shocked and completely at a loss!  I asked her what their reasoning was because I was STILL in a lot of pain!  She told me that they said that physical therapy was, “not medically necessary.”  I hung up shortly after hearing this and focused on holding back my tears instead.

I worked with Kristen on the last Thursday before my return to work.  I hadn’t told her about my appointment with Dr. Frush so I was excited to get her take on it.  When I got there, I explained everything.  What he said, my MRI results (the Pac-Man chunk), and the lack of improvement after the cortisone shot.  She listened as she rubbed my knee out.

I told her that I was a bit concerned that I was returning to work with my knee still hurting.  Dr. Frush said that I didn’t need surgery so I guessed I just had to deal with the pain.  I had broken my ankle in March of 2005 and it tool 6 months to heal.  Having MS has made my lower extremities slow to heal so I guess I just have to deal with it and take it as ANOTHER perk of having MS. Yay! (That “Yay!” is COMPLETELY sarcastic!!!)  I’ve decided that I REALLY LOVE physical therapy!  Kristen said after looking at my knee that she thought that the swelling in my knee has FINALLY gone down!  IT’S ABOUT TIME!!!

She hooked me up to stim. and iced me and I decided that I REALLY love that!  Kristen told me that  she would tape me, she decided to “double-cross” me (two layers of tape in the cross formation to reinforce things for my return to work) so she doubled up the tape across my kneecap before snapping my pants back up.  I got back into my chair and was grateful that I was “Double-Crossed” because it felt good!  I guess I am on the road to recovery.  Thank God!  It’s about time!  Finally!

I didn’t have tape on my knee because Dr. Frush had taken it off to give me my cortisone shot. I worked with Brad and told him all about my appointment with Dr. Frush, what he said, and about  my cortisone shot.  I explained how concerned I was that he said, “Yet” and that the cortisone shot was NOT the “numb-all” that I had expected.  My knee still hurt and it frustrated me!

Brad listened as he worked my knee a bit and then he pulled my foot to straighten my leg out.  I asked him if this was “manual traction” and he laughed, kind of nodded, and agreed.  He told me that he was, “Opening the Joint.”  As he pulled, I felt relief in my knee immediately,  It was like you don’t realize how much something hurts until it doesn’t hurt, even for just a little while.  I feel like I may have gasped when he did this.  The immediate relief was welcome because my knee has been hurting SO BADLY for SO LONG!  I didn’t want to talk about things that concerned me because him pulling my ankle felt SO GOOD!

I first told him my concern about the qualifier, “Yet” that Dr. Frush used.  Because my knee still hurt, did it mean that I might NEED surgery?!  My second concern was that the cortisone shot was not the “Numb-all” that I expected.  Dr. Frush told me that everyone reacts differently to the cortisone.  I wished that I reacted differently than I had.  My knee STILL hurts!  I almost wish I was part of the 3% of women whose face flushed temporarily as a reaction.  At least that would be SOME visible reaction.  Sadly, I felt nothing.  Not only was I disappointed that my knee STILL hurt but I wondered if surgery was in my future.

When Brad was done, he set me up with ice and stim. When my time was up, Brad came back over and told me that he wouldn’t tape me this time.  He wanted to give my skin a rest and told me that Kristen would tape me next time I was there which would be the next day.  I nodded in agreement and he re-snapped my pants.