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To Doctors I will go
blaisepascal
So Yesterday morning I went to see an orthopedist. My PCP referred me to him about 3 weeks ago, before the most recent blowup of cellulitis and calf pain, because of recurring left knee pain and visible swelling of the knee during my routine 3-month exam.

I can't say I appreciated the orthopedist's bed-side manner. One of the things he dictated into his notes was that the visit took over an hour of doctor time interspersed with waits for imaging, etc, over 50% of which was hands-on examination and discussing the diagnosis with the patient. If dictating his observations and sundry into his report in medical language, talking near me, but not really to me, constitutes "discussing", sure, I'll buy it. He also demonstrated to his MA how to tell the difference between cellulitis and hyperpigmentation due to chronic lymphedema by poking my left leg (which blanched when pressed, then reddened again as the blood reperfused the porous skin tissues) and my right leg (which remained red even when poked). I don't mind using me as a teaching example, but it would have been nice to be asked first.

Other than that, I think he showed a lot of skill. He dictated quickly a lot of findings from his exam into the report, including things I didn't notice him checking (like my gait when walking). There were some things he felt in the knee, including one this that was "positive" and something else which was "marginally positive", but I don't remember the terms he used to list those. He did not adequately tell me what those were or what they meant. I think next time I see him I'll ask if I can get a copy of the report, so I can read it with a medical dictionary/Wikipedia next to me. He did express a concern about the chronic lymphedema in my legs, and suggested that my PCP look into treating it more aggressively and exploring venous insufficiency.

He did get 4 X-Rays of my knees (one of both together, three of just the left, in 3 different angles (front, side, "sunrise"). He also is scheduling an MRI of my left knee and left calf to get a better handle on what might be going on in the knee and calf. The imaging showed that the left knee has some arthritis and also a mild bit of osteoporosis, which is unusual in men of my age.

When I was leaving, he was looking at the CT scans done last week on my calf, and he pulled me aside to show me the fluid pocket (I'll take his word it's there, I couldn't interpret the images well enough to see it), and to say he thought it likely a hematoma caused by a popped vein in my calf, which happens. The MRI will give more info.

I'm supposed to return to him after the MRI, but I currently don't have an MRI appointment. They need to pre-clear it with my insurer first. More info when that happens.

This morning I had an appointment with my PCP, as a follow-up to the ER follow-up appointment last Monday. He thinks my leg is looking much better, but just to be sure he prescribed another 10 days of oral antibiotics, with a refill available if I needed it. I told him about the orthopedist visit (he didn't have the report yet), and he reacted strongly to the osteoporosis indication. I am the wrong gender, wrong age, and wrong weight to get osteoporosis in my legs. He feels if it's really there, we need to find out the cause. He did clear me to walk to work again, if I could do it without to much pain.

I got a ride about half-way to work today, and the remainder of the walk took a lot out of me. One of my co-workers asked me if I was OK, and offered pain-killers if necessary (I said I already had Advil available, but thanks). Walking home is going to be more challenging.

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What did the PCP say about the chronic lymphedema being treated more aggressively?

He said that compression is commonly done for that, and may be a good idea, but it's a bad idea when there is an active infection going on. You don't want to disturb the infectious agent.

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