I was going to write an entry on the issue of trust when it comes to choosing/working with medical professionals and then circumstances meant that I’ve also come to the next phase of the pregnancy-related updates/data gathering so I figured I’d roll them all into one.
In terms of the main focus of the blog - and the more recent side turn down the road of Fitness, knees and pregnancies - I’ve been monitoring the knee during pregnancy and after having my little boy to record the impact (or otherwise) of shifting hormones on how it feels. After 14 months, he is finally completely weaned so the relaxin should hopefully start to dissipate over the next six months, taking the sore wrists, bendy elbows and, hopefully, the PGP with it. So it seems a good point to update the knee scores on the doors:
13 August 2019
IKDC - 56.3
OKS - 35
CKS - 54
In the interests of transparency, some of the questions are quite tricky to answer at the moment as the PGP is causing problems with even low impact activities such as walking so I’ve had to guesstimate some responses in light of how the knee feels in general. Whether it would feel the same in response to higher impact activities, who knows.
So, what brought me to the subject of trust? Being a month into PGP physio and basically not seeing any improvement to date.
The PGP is still very much there - varies day to day, hour to hour, but if I walk for more than half an hour it really kicks up a level and I even seem to pay for swimming after the event now too (just doing front crawl and back stroke as I know breast stroke is bad for PGP and is a no-go for the knee anyway). The knee also feels unstable more frequently - not to the extent it gives way completely, just shifting around during the day. The latter could be because we’re trying to retrain the right muscles to start taking responsibility for it or simply that I’m just more conscious of it, but it does make me question whether or not I’m doing the right thing.
I’ve touched on the issue of trust briefly before, following a couple of less-than-ideal experiences with physio and nursing care following the RevACLr and later cartilage surgeries. When admin issues meant physio with my preferred ACL physio team (the second to work with me following the RevACLr surgery) was potentially under threat, I asked my consultant for alternative physio recommendations but trust in the team I was working with meant I hoped I wouldn’t have to swap at all.
Once I was eventually signed off and went back to the gym, one of the PTs during my induction mentioned that my glutes weren’t firing and I was a bit p1ssed off that no-one had spotted that previously. But a couple of weeks later, I pretty much dismissed it as the PT turned out to be flaky to the point I didn’t bother chasing my final induction session.
Then when the PGP kicked in around half way through my pregnancy, I visited a specialist pregnancy/pelvic physio who advised my glutes were ‘permanently switched on’ and tried to release them before manually realigning my pelvis. That seemed to do the trick PGP-wise until the last few months of the pregnancy, by which point I felt I could ride it out.
When the PGP recently flared up again to the point I realised I was going to have to do something about it rather than simply resting and hoping, deciding where to go for advice wasn’t easy: Other than knowing I wanted to go to a physio that was a member of Pelvic Partnership , I wasn’t sure whether to go back to the physio I’d seen for PGP previously or go to another member of the network closer to home. (Working a four-day week means time is tight and any appointments would need to be during the working day as I can’t realistically take the now toddler with me).
Since I last had PGP physio, there is a new provider closer to my home and another one a similar distance away in the opposite direction to the one I visited previously. How to choose? A friend who has children a similar age to my own and who wanted to get back to high-level sport following the birth of her second mentioned someone she had been to see around six months ago so, out of interest, I looked them up online and started following their social media streams too. Over a period of several weeks, I began to get a feel for her approach and the posts seemed largely sensible. There was very little information available about the one closer to home - other than a basic profile on the wider physio practice's website - so, after much consideration, I decided to go with the physio recommended by my friend.
Which brings me back to trust. The new physio has also flagged the glutes issue (the third person to do so, which would suggest there is something in it) and I’ve been working on it for the last few weeks. But with no improvement in the PGP symptoms and even swimming causing flare ups too I have to question if this is one of those things that just has to get worse before it gets better or whether I’m really doing the right thing at all?
My next appointment isn’t until September so all I can do for the moment is take a leap of faith and keep going with the exercises in the hope it will take an upturn soon.
To be fair to her, her website talks about people often bouncing around between lots of different physios/medical people until they find the one that works for them but, in the nicest possible way, I really think I’ve had my fill of physios etc over the last few years. I just need to find something that works! I've always been compliant when it comes to doing my physio homework but it's only natural that you start to think 'why bother?' when doing what you're advised to doesn't seem to work anyway.
Of course, the same issues raise their head when choosing which orthopaedic surgeon you visit for your knee surgery (assuming you don't just go where you're sent by the GP/physio referral). Hopefully once this PGP issue is sorted out, I’ll be able to get back in the gym properly and finally rehab this blasted knee to the point I want to get it to but if not, where to go from there?
When I had the revision ACL surgery, I decided not to go back to the surgeon who did the original reconstruction - after all, it had failed and a fresh perspective would be valuable. I trust the surgeon who did the revision surgery (if not all of the supporting team) but the sensible approach now would be to get a number of opinions from different consultants. In reality though, particularly if you're looking in the local area, how independent are different surgeons? Almost everyone knows everyone anyway. Does your reputation as a hypochondriac/informed [delete as appropriate] patient follow you? Is it better to see someone who is fresh to your case and evaluates based on what they see now or someone who understands the history and isn't going to miss anything? Is it unreasonable to still(!) be seeking a solution?!
I’m over-thinking it but, based on personal experience and a lack of useful data in the public domain, for all of us I guess it's ultimately a matter of trust.