Friday, April 8, 2011 at 11:51PM 
Knee X-Ray, Scott Thieman, Flickr
Today we are publishing our new guide on knee pain designed to help you learn about the knee, understand the diagnosis of knee pain and then learn about alternatives to treat and manage knee pain.
Click here to read the Hurt.com Guide to Knee Pain.
Guide to Knee Pain in knee pain Thursday, April 7, 2011 at 9:57PM Welcome Marion to the Hurt.com writing team!
Name: Marion
About me: I'm in my mid-fifties and live with my husband on the Eastside of Lake Washington in the Seattle area. I’m a former academic researcher and now I work as a writer and volunteer. I'm passionate about helping people come through challenges and create better lives.
Experiences with Pain: Fibromyalgia, osteoporosis, knee and ankle injuries, osteoarthritis, back injury, Sjogren's Syndrome
Before I had cancer, I did a lot of hiking, backpacking and rockhounding. I also enjoyed a martial art, armored medieval foot combat re-creation. Over the years I had repeated ankle and knee injuries, plus the occasional back injury. I've re-conditioned and healed a great deal, but I have to be careful to stay in shape and not aggravate old problems. Staying flexible and maintaining good balance is important to me.
Around age 30 I began to have trouble with dry eyes, eventually diagnosed as Sjogren's Syndrome. Although my case is mild it requires that I actively manage dry eyes, nose and mouth and sometimes other symptoms. People with Sjogren's also have a higher risk of lymphatic cancer.
At age 35, I was diagnosed with Stage III Hodgkin Lymphoma. I underwent a chemotherapy regimen called ABV-MOPP. Thankfully, the treatment cured the cancer, but left me with fibromyalgia, osteoporosis and peripheral neuropathy in hands, arms and feet. Managing these and other aftereffects of treatment is a life-long commitment. I walk and do yoga to stay in shape, and still go hiking in summer.
Osteoarthritis runs in my mother’s family and I have it in my neck, knee and hands. My sister also has fibromyalgia and osteoarthritis.
I choose to manage my pain as much as I can with alternative therapies because I tend to experience side effects from drugs. Fortunately, there are many other ways to approach chronic pain!
Why Hurt.com: Making a commitment to Hurt.com lets me share what's worked for me, so that the knowledge can help others get a head start. Learning to work with practitioners, make lifestyle changes, engage with remedies and treatments and understand research is powerful "medicine" for managing chronic pain.
Favorite Pain Management Web Sites:
http://www.webmd.com/pain-management/default.htm
http://nccam.nih.gov/health/pain/chronic.htm
http://www.sjogrens.org/home/about-sjogrens-syndrome/living-with-sjogrens
Monday, March 28, 2011 at 1:14PM 
Hospital Team, ReSurge International, FlickrIn The Hospital, Down In The Dumps
Whenever a serious injury occurs to someone, there is often an associated feeling of being alone - even when family and friends are close by or still in the room with you. It may be a side effect of the drugs being administered to you or something to do with the injuries. Expressing your feelings can be difficult at an early stage of treatment and recovery, but can go a long way towards helping you deal with pain levels. Try to be more positive in outlook and not dwell on uncertainties to help keep your brain working in ways that diffuse and reduce pain.
Try to engage the hospital staff a little when your family and friends aren't around to keep your spirits up and to help avoid getting depressed about your situation. Should you already have issues with depression, let your nurses know about it if you haven't told any of the staff about it. The trauma center will have a variety of people available to help. You endured a physical trauma and are getting help - some help for mental trauma isn't beyond their scope or capability.
The Hospital Pain Management Team
At Harborview, there is an actual team of three doctors - two residents and an attending, who come around before surgeries proven historically to be painful and will go over the strategies in current use to help keep you from going over the pain edge. For me, it was the use of the standard intravenous pain meds with the addition of a femoral catheter block. This was inserted into my leg up at the inner thigh and threaded down to the nerves just above my knee to help block the pain signals that come from the repair sites below. From what I have read since about tibial plateau fractures, I'm glad they did the block. It's supposed to be one of the most painful recoveries imaginable without one.
The pain medications are not without side effects. Nausea is a big one for many people, including me. It took a couple of attempts at finding the right combination of pain reliever and anti-nausea drugs to work for me. The first attempts shut off my appetite and I continued to lose twenty five pounds of weight until we hit on the right mix. There is something to the old sage advice that a little extra weight isn't such a bad thing. Had I been at what I used to consider my ideal weight, I don't know how much weaker I would have become with my body using up more muscle instead of fat. Good thing I was a bit chubby, I guess.
The i.v. drip pain meds today have a controller that is a bit like the buttons used on "Jeopardy". Using this system taught me to identify the onset of pain when the medications would begin to wear off and the need to watch the clock to see how much time I would get from the dosage controller. It was set up to allow the patient (me) a dose every 15 minutes as needed, with one push of the button.
Pushing it more often or more times within the 15 minutes didn't work. This teaches one to pay attention to one's body signals, the machine and the clock.
Thanks to that infernal machine, I can now pick up on subtle clues that tell me it's time to grab some ice and Tylenol before the pain goes nuclear.
Stay On Top Of It
You may have had someone tell you about the difference in pain control when they either skipped a dose or waited too long to take something for the pain. It's true - heading it off at the pass, cowboy-style, does help keep it down to a dull roar. Once you let the pain get beyond control, it becomes much, much more difficult to reign back under to a manageable level.
Specifically, what I'm referring to is pain that started out as a twinge, a dull ache, or even a momentary pop, that then turns into a raging pain monster refusing to let go of your leg, arm, back,or whatever is ailing you. Keeping on schedule with RICE (rest, ice, compression, elevation) and your medications , as well as learning to identify the onset of serious pain and to deal with it in a timely fashion is the way to keep on top of it.
Don't Overestimate Your Strength
Before and after surgery you will be told what to expect in the way of recovery time estimates and how your progression though the different stages of recovery might go. The best advice I can impart to you at this point is to be acutely aware of weakness in the legs and back. You culd very easily injure another part of your body just when you need it the least.To enable my bones to start healing properly, I was non-weight bearing ( no weight whatsoever) on the repaired leg for three full months. After that, I was allowed gradual 25% weekly increases, while still using crutches. So, quads? What quads? The muscles that help stabilize knee joints were basically gone. I had to be extremely careful to not twist the leg when beginning to put some weight on it, and so should you if you find yourself in a similar situation. Yeah, it is necessary to push yourself a bit to improve and build strength, but don't be stupid about it. It takes time.
Here Comes Physical Therapy
In my case, the doctors had to bolt together a good portion of my lower leg.
Due to the high energy impact nature of the crash, the parts list of stainless steel screws, bolts and internal fixator was quite long, indeed (On more than one occasion, the x-ray techs at followup appointments missed getting a picture of the entire assembly since they rarely see one as big as the one that's a part of me now). A level VI (6) on the Schatzker scale tibial plateau fracture repair can have a high complication /failure rate, so physical therapy is no joking matter. You have to do it and do it correctly.
In order to keep your knee joint from freezing up and having significant loss of range of motion, many hospitals will start you on a CPM (continuous passive motion) machine right in the hospital bed. The idea is to get you moving the joint as soon and as much as possible before scar tissue starts to interfere with motion. The CPM machines kind of worked for me, allowing me to maintain a real range of about 48 degrees on the repaired leg. This in contrast to my other leg at 140 degrees.
When I started P.T. in earnest at the 48 degree point, every single movement was a challenge. I was still on crutches, non-weight bearing, with the hinged brace off for the sessions. Just doing simple stretches, then a few leg lifts was enough to have my leg remind me I was alive. (Yeow!) Looking back, it hurt but was absolutely necessary for me to be able to walk again without dragging my leg behind me. It took months, but I'm walking with only a small limp and can move my leg beyond 112 degrees. Not perfect, but I still have the leg.
Yay, Team !
You, your family, your doctors and nurses, and physical therapists all have to work together in order for a successful outcome after a major surgery or surgeries. Communication between everyone is a critical component to avoid relapses, re-injury or more surgeries. If you notice that something isn't working or there are differing opinions on how to proceed in your recovery, stop the show and hash it out. Get up to date information and make informed decisions. It's your body and you have the final say on what to do with it. It's your team and you are allowed to make substitutions where you deem appropriate.
No more sports analogies for now, I promise.
Dave
Shoreline,WA
Friday, March 25, 2011 at 12:32PM 
Emergency Room, Chealion, FlickrWhere should I go?
When I had my motorcycle crash and received a severely broken leg, I had no idea that the hospital I had chosen to be taken to for treatment was a level IV trauma center. Nor was I aware that Washington State uses a 5 level rating system for the various hospitals/trauma centers associated with these hospitals. The trauma nurse and doctor at Northwest Hospital looked at my x-rays and discovered that they were going to stabilize me for transport and that would be about it. I was going to need much more surgical specialty personnel than was immediately available for them to muster. Oh, joy. Another ambulance ride.
The pain from being moved around for a dozen x-rays was getting to the point where medications alone weren't effective and it was time again for distractions and daydreaming - taking my brain away from the pain, like with the Shoreline paramedic talking with me about my once- beautiful bike (Grrrrr!). Yup, that worked and now that I know it will only work for a couple of minutes, I started thinking about trips my wife and I have taken - standing on the observation platform atop the Eiffel Tower in Paris, gaping at the Crown Jewels in the Tower of London, watching humpbacked whales in the Strait of Juan de Fuca ; the vivid, Technicolor type memories that are forever etched in your mind. Those memories are the ones that seem to work best to push pain down and away. I still felt it, but the pain was much more tolerable and allowed the medications to work better.
Trauma Center Ratings
Level V (5) is the lowest rating for a Washington trauma center and level I (1) is the highest. If you live in Washington, Idaho, Montana or Alaska and need a level I trauma center, you will be going where I wound up - Harborview Medical Center, Seattle, The State of Oregon has two level I trauma centers in Portland to help cover that state and SW Washington.
The trauma center with a level I rating is going to have 24/7 staffing and on-call availability of every specialty doctor, nurse, anesthesiologist, and technician that severely injured people might need, including burn and plastic surgeons.There will also be on-site most diagnostic and imaging devices these specialists will need to help fix you up. In my case, it was for the orthopedic surgeons. (Yay, HMC Green Team!) The centers with levels II, III, IV and V will triage patients, and if they can be stabilized, they will send them off to a higher level facility that will have necessary staff waiting or on the way when the transferred patient arrives by ambulance or helicopter. There are many rules of triage and transfer these trauma centers follow and these guidelines vary from state to state. Look up specifics for your state or states you're likely to travel through as part of a pre-trip planning guide. It could help steer you towards a better choice and eliminate unnecessary transferring. And unnecessary pain.
Triage at the Trauma Center - Three Days Without Food
One thing to keep in mind about trauma centers is that they are very busy places, indeed. The Friday I crashed was the day before the Seattle Seafair festivities began and man, was that hospital busy. Remember I mentioned triage?
If your condition is relatively stable or can wait for treatment, you will probably wait. Here's where the letting your mind wander technique can help, especially if you're bored with watching tv or there's no tube where you've been stashed. Once a code blue is called on your floor, you will have to wait for more pain meds until the emergency is over and your nurse is freed up. You may have to deal with the pain one on one, using the power to reduce pain your mind has built into it - you against the pain beast. Kick the beast where it hurts, but remember to stay calm, relaxed,centered, sitting on the beach or wherever it is you choose to go.
The nurses called it "getting bumped" or as I found out, no food for three days.
Each time I was scheduled for the first surgery to install an external fixator (lovely piece of equipment - Google it to see examples), someone more seriously injured would come to have their life saved. Usually. Not everyone who made in in survived. I didn't have anyone die next to me, but a temporary roomie did.
Once, I made it as far as having the surgeon initial my leg and have the sleepy-time guy go to get the good knockout drops when Nurse Killjoy came in again to bump me. No ill will towards those bumping me, but three days without food made me a little cranky. Seafair weekend in Seattle gets a lot of torn-up people into the hospital, and depending upon what is going on at the time you're ever admitted to a trauma center, be prepared to wait.
Distraction Pain Control
Practice a little distraction pain control at home before you really need it.
Practice controlling your breathing and breathe like an opera singer - slowly, from the diaphragm, up and down, not in and out. I got pretty good at it and found that I could slow my heart rate quite a bit and lower my blood pressure (being hooked up to monitors made it easy to quantify). You can learn how to do it, too, Use it to work on relaxing pain away a little at a time, one spot at a time.
Dave
Shoreline, WA
Thursday, March 24, 2011 at 12:52PM 
Ambulance Returing to Hospital, Chris Wong, FlickrYou Crashed Your Motorcycle. Now What?
All of the people you need to process the scene of your incident have arrived, you're in a lot of pain, and they all want to ask you questions and be given answers at once.
If you are lucky to have an adrenaline surge (as I did), that will help control the pain level for a few minutes at best. Start using breathing control - regular, slightly slower than normal breaths to help keep it together. Yeah, it still hurts, but there are important decisions that can't wait for answers to be dealt with right now and this will help you get through it.
Where do you want to be taken?
If you are conscious, tell the emergency personnel your wishes. Ask for their advice if you aren't familiar with the area or are not sure about the severity of your injuries. Now what about cases where you are NOT conscious or coherent?
Your wallet should have your I.D. in it, and the police and paramedics need information. Secure an old business card in your wallet where it can be easily found that has ICE wriiten on it in big letters (In Case of Emergency). Put your emergency contact person's phone number on it and your wish to be taken to a trauma center if at all possible. Remember, you're a motorcyclist: it's not a matter of IF you will crash, merely a matter of WHEN. It took me 38 years, but it happened.
What about towing the remnants of your bike/car?
Ask the police to inform you of where it is going and for them to provide a phone number and address if available. The tow truck driver can also leave a business card with you or the police. There are daily charges for impound and storage that you insurance may or may not cover fully.
Speaking of insurance...
Have your ICE person contact the insurance company if you are not in any condition to call Sooner is better than later. Once your people know you are on the way for treatment is the perfect time to call. If they have come to the scene, they can get business cards or at least phone numbers to contact all concerned parties.
Motorcycle insurance is not required in all states, but I highly recommend it none the less. Health and disability insurance are also nice to have, since the bills can easily exceed $100,000.00 for a two or three week stay in the hospital. Check your policies to see if you have personal injury protection and gap coverage if you're making payments. The bank wants their money and doesn't care if you are broken into little pieces.Check around and price shop for decent coverages, it will be worth the effort should you ever need it.
OK, now it's really starting to hurt !
When someone who has had severe pain episodes tells you that it is necessary to be ahead of the curve, listen to them. Waiting too long, until the pain become intense actually makes it a lot more difficult to get back under control. Paramedics may or may not be able to give you something for pain. If not, do you best to try to relax, breathe, and think about the most pleasant place you've ever been in your life, the most pleasant experience, etc. Take your brain away from the pain - it really can help.
Being moved around - Hey, be careful!
Broken bones hurt when they are twisted, so keep emergency responders informed about where you are injured to minimize that problem. Splints help, but aren't perfect at immobilizing limbs, especially when you are lifted and moved from gurneys and exam tables. Watch out for three person lifting teams if you weigh more than 180 lbs. as I do. A fourth person may be needed to move you carefully enough to avoid major pain.
At the hospital emergency room.
The doctors and nurses will probably come around and ask you, " On a scale of 1 to 10, 10 being the worst pain imaginable, what is your pain level right now?".
Tell them honestly where it hurts and how much pain you are feeling. Depending upon your types and levels of injury, you may not get much pain relief right away. The pain medications can have bad side effects that could interfere with treatment and your ability to breathe, so hang in there as long as you can against the throbbing. Nothing they can give you will take away all of the pain and allow you to be awake, and they have a million questions to be answered again and again. Once they get all the the answers they need, you will probably be given enough pain meds to allow you to drift off to sleep.
Staying Positive
Keeping as positive a frame of mind as you can is probably the best thing you can do to aid in your pain level control. You may not be able to walk or even get out of bed, but you can try a variety of mental routines to distract yourself from the pain. It can really work. For a few minutes, riding in the back of the fire department aid car, the small scrape on my pinkie hurt worse than the leg broken into eight pieces. I had been talking to the paramedic about my bike and had become angry again at the jerk who caused the crash. Probably not the best sort of distraction, hey, it worked!
Next up in the series - What Is a Trauma Center?
Dave from Shoreline
