#1---"not using heat if there is inflammation/swelling if this was done in the begining did I add insult or agravation to my knee are? I was using a heating pad and Icy Hot ointment"
Redness, swelling, pain, and heat are the four signs of inflammation which is your body's healing response to damaged tissue. Blood flow increases to allow more immune cells cytokines and nutrients to reach damaged tissues. When inflammation is present (no matter when or for whatever reason) then the cells lining blood vessels allow large protein molecules and water to escape the bloodstream and enter the inflamed tissue resulting in swelling. Swollen tissue presses on nerves in your knee causing pain. Therefore, logically, you want to avoid the pain by reducing the inflammatory response (swelling and heat) not increasing it. Adding heat to a hot swollen red painful knee will increase the inflammatory response resulting in more damage to the tissue and pain. This is why I advise my patients never to apply heat to a swollen joint. Once the swelling has gone down, then heat can be applied. Heat is comforting to a non-inflamed joint because it helps to increase the circulating blood flow to heal the damaged joint. Just remember never apply heat to an inflamed area. Once inflammation is gone then heat is all right.
#2---Can I use Icy hot even so at this time? That would help me to sleep.
Icy Hot contains methyl salicylate (30%) and menthol (10%) which are rubefacients that cause dilation of the capillaries and an increase in blood circulation. If your knee is no longer swollen then certainly you can use Icy Hot. However, do not use Icy Hot or a heating pad if you have an inflamed swollen knee or you will cause more swelling and pain.
#3---"I'm going to fight to be referred to a Rheumatologist but having a Kaiser Permenete HMO is like pulling teeth trying to get a referral"
Telephone your personal physician at Kaiser on Monday morning and politely remind them that a rheumatology referral is strongly recommended when a patient's pain persists for more than 6 weeks. Tell them that the cost effectiveness of a rheumatology consult far outweighs the consequences of a non-treated knee problem. Persistent inflammation and pain beyond 6 weeks indicates a joint problem that only a rheumatologist is sufficiently capable of diagnosing and treating effectively. Tell them that the cost of your incapacitation due to their lack of response to your complaints of pain are significant. Your income has been affected. Your emotional well-being is affected by constant pain. Your family, including your disabled daughter, has been affected by your immobility and your pain. The consequences of Kaiser's inattentive attitude have been costly for you and your family.
If your physician will not give you a referral, for whatever reason, then telephone the Medical Director of Patient Care Services and explain that you have spent the last 7 1/2 weeks with severe unrelenting knee pain. The pain is over-whelming and incapacitating. You have not received appropriate treatment by your attending physician. Tell the Director if Kaiser won't treat your pain then you will go outside of the Kaiser HMO to receive treatment. The outside physician will bill Kaiser for their second opinion and their subsequent appropriate treatment for your knee.
An anterior cruciate ligament tear is a serious injury leading to destabilization of the knee. Price Range: low = $ 11,767 high = $ 13,072
#4---"how much does a private opinion usually run monetary wise?"
The cost of a second opinion is variable based upon who you are receiving the opinion from.
The AMA endorses the principle that it is appropriate to provide payment for a second opinion when medically necessary or required by Medicare. (Res. 65, A-87; Modified: Sunset Report, I-97). Kaiser receives Medicare funding; therefore they must abide by Federal Medicare guidelines and pay for your second opinion.
When you tell your doctor that you want a second opinion then your doctor will send your medical records to the doctor giving you the second opinion. That way, you may not have to repeat the tests you already had.
During the visit for a second opinion, be sure that your new doctor knows what tests you have had and that you specifically want to discuss the appropriateness of having surgery on your knee or at least injections of corticosteroids/analgesia and ultrasound treatments with more appropriate physical therapy including whirlpool treatments.
#5---"He doesn't want me to use a wheelchair because he say's the resticting me using my muscles"
The treatment for knee pain and inflammation is to rest the joint and avoid activities that aggravate the pain especially weight-bearing activities such as ambulating. Most patients cannot use crutches. They cannot balance sufficiently well to avoid placing weight on their injured painful knee.
I advise weight-bearing activities after your pain is controlled. It is ill-advised to use crutches to ambulate if you have a painful knee. A physician should treat your pain so that you can gradually participate in your individualized comprehensive physical therapy program. No two patients are alike. Each patient requires an individualized approach to returning him/her to their pre-injury state of health.
If you have additional questions I will gladly answer them.
Dr. H
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