Why this Plica makes me sad…

Today a patient came to see me with knee pain that she’s had for over 6 months. She had been to see a variety of care providers at different locations around the globe. Radiological imaging was performed and the resounding result of all her previous exams and imaging was “Nothing Found.”

Usually I get defensive when a patient with this background comes in, as it triggers my “scammer alert” instincts. Upon interviewing this patient it immediately became clear that she was in legitimate pain and was frustrated that “no one can see it, feel it or tell me what’s wrong, but I just know it hurts.” Game on!
The interview revealed she could run 2 miles very quickly, but has some pain after, stairs frightened her, and sitting in meetings really hurt. My physical exam lasted all of about 3 minutes, including several special tests to rule out any injuries not suggested by her history. She had a patella plica. (And here.)
This is a small fold of soft tissue that everyone has between the kneecap and femur. In some cases, it becomes angry and hurts. It is not uncommon and is really a simple diagnosis to make. Her treatment would include some basic stretching and strengthening, and a referral to an orthopedist for a steroid injection. With any luck we can avoid surgery. Her prognosis is good.
So what makes me sad about this plica? The fact that no less than 5 physicians examined this knee without findings and this poor girl was labeled as a scammer. This story underscores the importance of seeing a musculoskeletal expert for musculoskeletal pain.
Who are these experts? Physical Therapists and Orthopedic Surgeons. That’s it.

God Bless You, Mr. Vonnegut…


Kurt Vonnegut has died. He split his head in a fall and last night he died. And so it goes…

“When the last living thing

has died on account of us,

how poetical it would be

if Earth could say,

in a voice floating up

perhaps

from the floor

of the Grand Canyon,

“It is done.”

People did not like it here.”

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Can Exercise Help Breast Cancer?

Perhaps not directly, but a recent BMJ article says it can help in improving physical function and quality of life measures in patients with early stage breast cancer. Some of the physical measures noted were a 12 minute walk test and a measurement of shoulder mobility. Interesting to note, the physical measures improved right away, but it took some time for the quality of life measures to show an intervention effect.

There have been a series of studies (and this one) recently dealing with the issue. I find the concept refreshing, as it really makes sense to get some supportive literature behind some good integrative care. Perhaps with enough of this type of literature, a woman diagnosed with breast cancer will be able to receive treatment not just for her cancer, but also for her receding quality of life and upper limb function…and have it reimbursed!

There's a Fungus Among Us!

I may have mentioned this in a previous post, but this article provided a nice overview of the events surrounding the emergence of a potentially fatal fungus in the Pacific Northwest.

A quote from the article:

“An alien fungus took root on Vancouver Island eight years ago and has since killed eight people and infected at least 163 others, as well as many animals.”

Pharmaceutical Serendipity

One very popular instance of serendipitous research occurred when Pfizer was working on an angina medicine and discovered the profound effects of Viagra. Here is another, less popular instance…The Anti-Hoarding Drug!

Patient Conversation of the Week

Excerpts from especially memorable patient encounters:

ME: So what made your back pain worse?

Patient: The Physical Therapy made is worse.

ME: Well, what did you do in PT?

Patient: What they told me to do.

ME: What did they tell you to do?

Patient: Things that hurt.

Excellent!

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