What to do when your patient is yourself. A personal story of my ongoing Medial Meniscus Tear. Part I
Apart from being a professional, I’ve done a lot of absolutely stupid things in my life. I’ve raced road bicycles and hit the pavement at 35 mph with 20 guys crashing on top of me. I’ve taken 25ft falls on my mountain bike, landed on my feet and was able to walk away. I’ve face planted in the water doing 30 knots while barefoot waterskiing. I’ve gotten frostbite while snowshoeing. I’m still picking rocks out of my right hip from sliding 75 feet down a gravel road at Hunter Mountain Ski Bowl in the Catskill Mountains from 13 years ago.
Despite all of my stupid and reckless adventures, I recently tore my medial meniscus on my right knee picking black raspberries in my garden this past July.
I’ve been nursing it along for the last two months. I’ve been able to work and ride my bike with minor complaints, but deep knee bends have continued to bother me. I made the mistake last week when I went on a 5-hour mountain bike ride. It absolutely over worked my knee and I immediately experienced severe swelling for 48 hours, limited range of motion, and I was limping like I had never limped before.
I finally went to my primary care physician last week. He agreed that it was probably my meniscus and prescribed non-steroid anti-inflammatories and ordered an MRI.
The funny thing about being an Orthopedic Specialist and having your own orthopedic injury is that it’s really hard to be objective. It’s easy to be objective and logical when it’s not your knee, and it happens to be a patient’s knee sitting in front of me on any given day. But when it is your knee that hurts and you’re worried that you won’t be able to dance at your own wedding in three weeks, how can you not be emotional about it? So here is a little taste of what goes through a physical therapist’s head as he tries to manage his own injury, not have surgery, and get back to his crazy life. You may find that you can easily relate…
I’m not ready for an MRI yet
My PCP ordered an MRI but I made the decision to not go through with it. I haven’t met my deductible for the year so it was going to be about $750 dollars in out-of-pocket expenses. Since I wasn’t considering surgery, I didn’t see the value of imaging at this point. I didn’t have any obvious joint locking to suggest a large tear or loose fragments. I had a physical therapy colleague of mine perform a physical therapy exam on me, and the orthopedic test for a torn meniscus did not provoke symptoms. This suggests if there is a tear, it’s not a big one, or one that requires a great deal of medicalization at this point.
Why not just have surgery?
After working on my deck last weekend, I swore my knee would need surgery as I could feel things sliding around in my knee. Two days later, my knee felt the best is has in about two months.
There has been some controversy the last few years about surgical interventions in the knee, as some good research has shown that surgery has about the same outcome as conservative care. A recent New York Times article has a good summary about the risks and benefits of surgery. You can find the article here: http://www.nytimes.com/2016/08/04/upshot/the-right-to-know-that-an-operation-is-next-to-useless.html?_r=1
There are parts of the meniscus that has a good blood supply and parts that don’t. If I tore the meniscus in an area that has good vascularity, it can probably heal on its own if I don’t do anything (once again) stupid. If it is torn in an area with no vascularity, the meniscus will not heal, but it does not mean I won’t do well. I think that will depend on my activity level. As of now, my goal is to race in the Iceman Cometh Mountain bike race in November 2017 and I’d like to start training in the next 30 days.
I’m taking an active role in my care:
I’m trying to be Mr. Proactive about doing everything I can right now. No twisting, no knee flexion past 90 degrees, and cycling a few times a week with light to medium pressure on the pedals. That means grinding the pedal climbs and city limit sprints are currently not allowed. I had some remodeling and landscaping projects I needed to complete by the end of the month and I’m being careful not to squat or twist. Easier said than done! I am able to work and be on my feet all day without moderate or severe pain, although I do get minor pain with prolonged sitting that gets better with taking a quick break by walking and moving around.
I’ll tough it out and see how well I can do without surgery. Since I’m on my feet all day, it would be hard to take that amount of time to recover from surgery and go right into full time clinical practice.
I’ll let you know how it turns out:)