Saturday, June 9, 2012
Tuesday, June 5, 2012
For once I’ve a good reason for being negligent about my blog. Pain is a mighty nuisance. It’s also thought-provoking.
Last year in September I was climbing the stairs to my office on the 7th floor when I began to hear a clicking sound in my left knee. As the clicking got louder, so did the sensation of a tentacle sliding around in there. I went to the doctor. He recommended leg lifts to strengthen the quadricep muscles that support the knee. When I did these, my back hurt. I went back to him. He said the problem was minor and I should keep doing the exercises, and if after a few weeks, the problem didn’t go away, I should get an x-ray. It didn’t go away; I got an x-ray. He said the x-ray was normal, and, yep, keep doing the exercises. By now it was mid-October. The problem had been ongoing for about 5-6 weeks. Climbing stairs to the sound of that whipping tentacle was becoming routine, as was knee pain, as was swelling in my leg if I sat for more than ten minutes. The Dr. prescribed Ibuprofen for the swelling but I had a reaction to it and the swelling grew worse. And then one day, on a pebbly walkway in Lyon Arboretum, the pain was just too severe to go on. I called the Dr. again. He said he’d refer me to an orthopedist. I waited over a week. Eventually, Dave had to call the doctor’s office and yell at them to hurry up and get the referral; the referral came. Thank you hubby, but damn you, world, for listening more to men.
I’ll try to make the rest quick. The orthopedist said the x-ray wasn’t normal. My left patella, or knee cap (you have to admit, patella has a ring to it), had tilted way out of its groove. He showed me the image; the knee cap looked like a tiny saucer teetering at a steep angle over the right lip of a small cup. How’d it get there? Most likely, I was born with imperfectly positioned knee caps; my right patella also tracks at a diagonal. But on the left side, the angle had become extreme. Why? I still don’t know. It might be that just a month earlier, I’d gotten a US driver’s license and begun to drive in hilly Honolulu, forcing the clutch knee to work over-time. Our car – my first ever! – is a Honda Fit; zippy and nicely-sized but with pedals that rise too far off the floor for me. My left leg was never comfortable while driving. Or it could be the gym, where I’d begun to use elliptical machines a little manically. Or yoga. Qui sait? The bottom line, well, my knee cap wasn’t tracking properly, thus straining the tendons and causing the quadricep muscles to atrophy. He recommended physical therapy. He also gave a steroid injection to bring the swelling down.
I promise I’ll make the rest quick. The day after the injection I had trouble raising my left leg at all. Where before I could climb stairs – albeit with sound and fury – now I just couldn’t lift the leg. Stairs were impossible, but so was just plain walking. I mean, I couldn’t even walk over a television wire. I couldn’t sleep. Absolutely no position worked. I was terrified and angry. By the time I saw the physical therapist (in November), she said it was the worst case of patellofemoral pain syndrome (PFPS) she’d ever seen. The knee cap was completely stuck. It was no longer teetering at that precarious angle but completely fixed in it. The muscles of my left thigh were gone. She was also the only one to admit that sometimes a steroid injection isn’t the right choice – it can damage connective tissues, like cartilage – though, and I’ll concede this grudgingly, when Ibuprogen and other NSAIDs can’t be had, it does bring the swelling down. But so does ice. Neither the general physician nor the orthopedist told me to ice, not even once. The therapist added that she tells her patients to first try ice and PT without the shot. So to anyone out there with similar symptoms reading my blog, first see if you can ice, rest, and exercise without an injection.
But to go on (okay, I admit I can’t be quick), I couldn’t do the exercises, even after the shot, because my back hurt too much. Turns out my right hip rides higher than my left. Like the position of my knee caps, this “abnormality” has probably been there for some time, but because the knees carry the back, with one knee out, the misalignment in my back had become more problematic. For most of December, the therapist worked on improving the alignment of my back. Her technique was interesting. I’d lie on my stomach and she’d ask me to cough. Each time I coughed she pulled my right leg and this brought the hip into place. It worked for a few days, but then the right hip would climb up again. Needless to say, the pain sucked. Plus, my right knee had begun to hurt as well. With the left knee and back not working properly, the right knee was compensating – and protesting.
By February the therapist conceded there were very few exercises I could do without aggravating my back further, grossly slowing down improvement of the original problem – petallofemoral pain syndrome – which by now had morphed to chondromalacia, or the thinning of cartilage under and around the patella. I also developed knee bursitis, or the swelling of the bursae (fluid-filled sacs) around and behind the knee. Don’t you love these fancy terms? (Bursitis behind the knee is especially hard to get rid of and causes pain all the way down the back of the leg.) Most aggravating of all, my mobility was still poor. Stairs were completely out. So was/is driving. (I haven’t driven since last September.) Even bicycling, generally believed to be excellent for the knee, had become difficult (and still is. On the downward rotation, both knee caps stop tracking and start clicking). And I also developed bursitis of the hips (and still have it).
Yet, around mid-March, I did start noticing tiny – I mean really, really tiny – improvement. The left patella had become a little looser and tracked a tiny bit less at that alarming angle during certain activities like walking, or when I did leg lifts (not in the position I was told to do them back in Sept). I could see a little more muscle. I could do the leg lifts with weights. Kinesio tape also helped. From February-late April I wore it in a “C” around both knees, and even now, I sometimes have to tape up again when the tracking goes. I still ice daily, including my lower back and around my hips. And I exercise diligently every day – I’ve missed only two days from November to this day in June. Today I have yet more muscle in my thigh, though the back and pelvis are still quick to tweak. There are still many activities I can’t do (like swimming; pure heartache, but the breast stroke is bad for the knees and I can’t do the front crawl). I’ve had all manner of tests to check for why recovery is so slow – MRIs and bone scans and x-rays of just about everything. The good news: the tests are normal. The bad news: no one knows if there’s an over-arching reason for it all.
I said at the beginning that pain is thought-provoking. It is. I am never not shocked. How did I go from being flexible, active, and lithe, to creaking like an old person? I’m not going to be my mother and believe that this is a divine test. But I will notice all those, both old and young, at the gym, on the beach, in lines at the movies, or at work, who are just as frustrated as I am when the elevators don’t work or when they can’t run or swim or squat. I also notice those who are physically strong, particularly young women. And I compare them to the way I was a year ago, or ten years ago, or thirty years ago.
In Pakistan, as a child, I was never taught the importance of physical strength, unless it had to do with eating more in order to be “healthy.” Never exercise – though, without much prompting from others, I loved physical activities and did what I could at school and other non-public places. There’s so much paranoia about girls-in-public that by the time we’re in our teens, even the lively ones grow sedentary, a habit made worse by very heavy study-loads at school. Overall, sitting, either for tests and exams, or for leisure and entertainment, is a favored local activity, and most of the ways girls are taught to sit (cross-legged, for instance) are bad for us. No one talks about keeping female joints healthy by building and sustaining muscle by being active from a young age. I’m not blaming my frame on the way I was raised – I know a lot of it is just body-type; I’m small and thin – though maybe I am, just a little. Because here in Hawai’i, teenage girls are so, so much more active than Pakistani girls of the same age -- swimming, dancing, bicycling, running – and I try to picture them twenty or thirty years from now and I hope that if they end up with an injury, including one they have no idea how they got, their bodies will allow them to recover more quickly, and more fully. Ten years ago, when I completed Trespassing, I used this quote of John Berger’s as an epigram: “To look is an act of choice.” I have started noticing things I never noticed before.