Tag Archives: PRP injection

Doctor vs Doctor

It was been 19 months since I went into the splits and tore my hamstring. Yesterday, I went to a new orthopedic.

I began treatment with my first orthopedic about a year ago, last January. He gave me a steroid shot and sent me to physical therapy. After dry needling, massage, and strength training did nothing or potentially made it worse, he finally sent me for an MRI. He told me I had a minor tear with no details. He gave me a PRP injection then told me we were at the end of my treatment.

I had this initial PRP back in May. It cut my pain in half, so a vast improvement, but then it just plateaued. It was better but not recovered, improved but not healed. I was fine to deal with it. Besides, my doctor had given up on me and told me there was nothing more he could/would do for me. However, when the pain seemed to increase again and it was driving me from my bed at night, I decided it was time for an evaluation. If nothing else, to verify I wasn’t making it worse.

I understand that hamstring injuries are notoriously slow to heal. Yet the lack of any progress and appearance of regression concerned me. Also, my doctor’s treatment (or lack thereof) left me with so many questions. Was I doing something that could be making it worse? At what point should I be worried? I had to know, so I got the referral for a new doctor.

After just my one visit yesterday, I can say that my experience with this doctor is a night and day contrast to my previous orthopedic. I did not know the extent of my dissatisfaction with the first until receiving the superior treatment from the second. Allow me to compare the two experiences.

My first doctor and his nurse were very rushed and impersonal. They asked questions but did not seem to actually listen to the answers. I spent extended periods in the lobby and patient room, waiting. I told them in my first visit that I was there to resolve my pain. I then repeated this every visit, yet they never wanted to treat my pain. They only wanted to get me back to activity.

Conversely, this new doctor and his nurse were extremely friendly and attentive. At each stage, I waited for normal and reasonable amounts of time, yet they continually checked in on me to communicate a status update. They were so attentive that it was startling. They also both connected with me. They looked into my eyes when they spoke to me. They responded to the previous thing I said. They waited for me to speak as if they wanted my answers.

I felt so much more comfortable at the new office. I felt like I actually mattered instead of being dismissed and ignored.

When my first doctor got my MRI results, he told me I had a minor tear. That was it. Despite any queries, he only said that and also that the technician probably would have never seen something so insignificant had he not pointed it out. He and his nurse seemed to trivialize and minimize my injury at every appointment. Their dismissive demeanor made it feel like they either did not believe I was injured or doubted its severity.

I learned yesterday from my new doctor that this same MRI showed that I had a labural tear tear in the same hip. The outside of that hip also showed inflammation, most likely from the injury I had before the hamstring. He told me my hamstring had a partial tear, approximately 20%. However, he said, the tear was not on either edge, instead it was in the center of the hamstring, making it extra difficult to heal.

All information that would have been useful A YEAR AGO.

My first doctor told me I could have a steroid shot and gave me one. He told me I could have a PRP injection and gave me one. Then he terminated my treatment, deciding he was done and there was nothing else he could do for me (another indication to me that he did not consider me actually injured).

This new doctor explained my six different options and quoted me the out of pocket price for anything not billed to insurance. I could:

  1. Get a new MRI
  2. Get one or more PRP injections
  3. Get stems cells from a donor
  4. Get stems cells harvested from me without anesthesia
  5. Get stem cells harvested from me with anesthesia
  6. Have the reattachment surgery

Not only did he provide me these options with price tags, he then walked through the pros, cons, and his experience with each choice. He told me that surgery would be his last resort because, with my injury, it could potentially sacrifice the 80% healthy hamstring to repair the 20% damaged. He told me he would prefer the biologic options (PRP, stem cells), but PRP has the most data and evidence behind it. If he did stem cells, he would recommend harvesting my own to eliminate risk of cross-contamination or rejection.

Then he encouraged me to ask questions and share what I thought I would like to try first. I opted to start with another PRP injection, which he then provided me at this same appointment. Then he set a follow up appointment to check how the PRP took and determine next steps.

Yet, with all this, the most glaring and important distinction between the two doctors and my experiences with them was the administration of my PRP injections.

At my first PRP injection, the nurse took my blood and spun it down in the room with me. When the doctor came in, he had me bend over the examination table. This aggravated my injury and felt very awkward. The nurse jabbed the ultrasound into my butt while the doctor stabbed the needle into my tendon. Afterward, he informed me this was all he could do for me. When I told him I really needed something for the pain, that the constant pain was affecting the rest of my life and making me short with my children, he reacted as if I had never mentioned pain and was drug seeking. He gave me Tramadol. As if being unconscious would solve my problem.

Yesterday, the nurse took my blood. While she was waiting for it to spin down, she checked in on me and told me how much longer I would be waiting. She set me up laying on the exam table on my stomach with a pillow. When the doctor came in, he covered me (as much as he could) with a paper blanket. He informed me he was going to start the ultrasound and placed it gently against me. He told before he marked for the injection and inserted the needle. He communicated each step before taking it. After, he sat down with me, and we discussed recovery and expectations and follow up appointments. He shook my hand before leaving. Then the nurse came in and set up my appointment before walking me out.

The two experiences of the exact same procedure were so different, so polarized. After the first one, I felt very uncomfortable and unnerved, generally unhappy. Being bent over the table, stabbed, and then dismissed so impersonally made me feel violated somehow. It never sat right with me and doused any hope I had that the injury pain might actually subside.

In contrast, I left yesterday’s appointment feeling optimistic. I felt like the doctor had actually heard me and I once again had options. And even if my circumstances do not change and the injury does not heal, I at least feel like someone gave a shit and tried. It was simple subtleties and seemingly insignificant details that made me feel violated and dismissed versus cared for and treated. I don’t think anything unethical or inappropriate happened at my first shot and I don’t necessarily doubt my original doctor’s medical knowledge, but I do see now how wholly unsatisfied I was with the treatment I received from him.

These experiences reminded me how individual doctors are and how unique a medical experience can be. Getting an injection is not just getting an injection. The circumstances, environment, and care are crucial factors. I am hoping a more favorable experience cultivates more favorable results as well.

For now, I will be on the couch, willing my body to heal itself.

 

Christina Bergling

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Accepting Limits

Happy anniversary to my hamstring injury! August 5th marked one year since the day I tore my hamstring doing the splits after a dance class at the gym. In that split second of blinding pain and squelched panic, I never would have imagined the long journey here. I remember thinking that a 6-week recovery would have been unbearably long.

How I have been humbled in this year.

I am not patient. Not in any way in life. In fact, impatience could be considered one of my defining attributes. Yet this injury, with its stubborn and unrelenting control, has tamed me. As much as I imagine I can be. I have learned about myself, my body, my mental strengths and weaknesses. I have been trapped in physical and emotional discomfort and forced to deal.

Not unlike learning to be bipolar all over again.

I think it was when I reached my PRP injection that I fully appreciated respecting my limits. I do not have the concept mastered. The muscle memory to my impulses tempts me to constantly push too hard, ignore the pain, revolt against the restrictions of healing. Yet I am learning to perform my cost-benefit analysis on a longer timeline.

Do I want my hamstring to heal back together? Do I want to run now or for all the years after this? Do I want the constant pain?

The PRP injection, placebo or not, reduced my pain greatly. The relent on my nerves brought back a measure of clarity and logical thought. It all seems easier now that I do not feel so desperate to escape my damaged skin. I can be persuaded to obey with the carrot of recovery dangling on progress.

With progress on the leg and a return to some measure of a fitness routine I can live with, I turn my mind now to continuing to heal the damage of my pseudo eating disorder. The symptoms surged when I gained weight during my “rest period” after my injection. I found myself riding a familiar binge (all the food) and purge (all the exercise and none of the food) cycle.

Yet instead of falling into this trap again, I am going to apply the lessons learned at the mercy of my hamstring and accept my limitations. I am going to stop punishing myself with food that only leads to weight that I punish myself more for. I am going to stop trying to hate my body because it is the wrong numbers. I am going to focus on my health, my strength, my happiness and hope that my flesh follows the suggestion.

Overall, I am going to draw the line here, between my head and my heart, and accept my limits.

 

Christina Bergling

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Plasma!

Three weeks ago, I received my platelet-rich plasma (PRP) injection into my relentlessly injured hamstring. This came nearly on the day of nine months since the injury. It still unnerves my mind to consider all of these months of constant pain sprung from one split second of lifting my hands as I was doing the splits. Yet, after so little change so many months, this procedure was hope.

As a recap, a PRP injection includes removing the patient’s (my) blood, spinning it down to the platelet-rich plasma, and injecting that mixture directly into the injury. This is said to stimulate the body’s own natural healing. The procedure itself is brief and out patient.

The procedure was uncomfortable, as advertised. I bent over an exam table, a hole strategically cut in my awful paper shorts. My doctor’s assistant dug the ultrasound wand into the flesh of my buttcheek as the doctor struggled to make the tip of needle appear in the field. He did not find it quickly or easily. Zings and flares flashed over my nerves as he moved the needle side to side and poked it deeper into my joint.

I just breathed and tried not to focus on the pain. The pain snapping at my spine, riding my synapses in waves. My body flinched and jerked involuntarily. I tried not to focus on the detached way the doctor worked on me like an inanimate pig carcass and his assistant called me sweetie to compensate.

The pressure increased as the small amount of spun down plasma was deposited directly in my injury. Then it was over. Of the variety of medical procedures I have had, this was definitely not the most painful. Unpleasant for sure but at least brief.

The worst part of the whole experience was trying to extract information from my doctor. Throughout his minimal appearances in my treatment, his (and his assistant’s) bedside manor have been lacking. Or I have failed to communicate my symptoms, like, at all.

I initially sought treatment because of my pain level. I was functioning fine, still able to be active. It was the pain. I told that to my primary care doctor then this orthopedic. I told them the persistence of the pain was affecting my personality and causing negative behaviors like yelling at my children too much.

And yet, this orthopedic treated me with the passing attention I would expect if I came with a mild ankle sprain. I had to fight to explain my symptoms. I had to nag to get any information on recommendations on recovery or activity. I had to get pain medication from my other doctor. He just seemed to not really take me seriously, either because he thought I was exaggerating or because he thought my injury was trivial.

In either case, it made the treatment and interactions in the office unpleasant and less fruitful. However, I was willing to indulge his medical expertise. He seemed knowledgeable enough, and it would have cost months to get a different referral for my insurance.

When I initially researched PRP injections (I had to Google on my own since my doctor provided zero information or expectations), I learned that the procedure actually stimulates inflammation in the injury to inspire your body to heal it. And since inflammation is the source of most pain, the information forecast a pretty miserable couple weeks after the injection.

However, I did not live up to that prophecy. It hurt, yes. I was exceptionally uncomfortable for a couple days but neither as much as I expected nor more than I had grown accustomed. Plus there were finally pain meds to take that miserable edge off.

But did it work?

I have just completed my two weeks of rest. Two weeks of zero activity. It was rough mentally. But, over the weekend, I was able to begin gently moving again. I have gone for a walk. I have taken a barre class.

And it is feeling better. Day by day, very slowly and incrementally, it is feeling better. I am not cured or fixed, by any means, yet the pain is retreating. I have pain medication that I am not even taking. I still have aches and zings and soreness, but I am not crying from the severity. I am not miserable and bitchy all day long.

I can feel myself starting to surface again under this injury.

I wish it was just cured. I was wish I was just fixed. I feel like I have earned it after this long. Yet it is happening painfully slow for my lack of patience.

Now the challenge is to temper myself. Every day it hurts less, I want to go run a half marathon (and I did not want to run another after I ran my first). So, prior to being liberated, I laid out a gradual plan to return to my normal activity level. I had to make it up myself since my doctor provided absolutely no post-procedure instructions. I had to interrogate his assistant for the slightest guidance then still just guess for myself.

I am on week 2. Two gentle workouts. A couple days ago, I went to barre for the first time. The origin of this entire mess.

I have not been active for really a month. In that month, I have put on about 10 pounds. Yes, emotional eating as I pouted over being inactive played a large role. Yet, it turns out that all my obsessive working out did serve a purpose; it was showing. I just did not notice until I stopped. Now I have to do all that work again, without being fanatical, without reinjuring myself. I am hoping that challenge will teach me to be more accepting of myself, to live with more balance.

My recovery starts over now. Not the nine months of suffering behind me. It starts over right now.

Right now, things are improving. Right now, I can get back on track with my eating and start easing back into activity. I can start fresh and maybe find some sort of sustainable balance this time. I wish I did not have to go back to trying to slim down again, but maybe this time I will appreciate where I was.

I am SO looking forward to getting back to running. It will be short and slow to start, but it will be far better than the nothing I am at right now. I want that time back. I want that sanity back. I want to feel like myself again.

Christina Bergling

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