Guest guest Posted November 25, 2002 Report Share Posted November 25, 2002 Dianne, The Synvisc has helped to delay replacements, so I hope you are one that benefits from it. I had the debridment done before getting mine replaced and it gave me a few additional years. It¹s good that you have options to hopefully delay replacements until you have no choice. a > Hi, Everyone, > > My MRI report was presented to me today. The news is " mixed " . > > The immediate observation was that both knees were loaded with scar > tissue, but not all of it was due to the earlier surgeries. Arthritis > inflammation in the joints has caused a lot of scarring. What to do? There > were some suggestions. I could have the joints " debrided " , which would be > done with an arthroscope, which would involve removing the inflamed tissue > and the scarring. I have had that procedure twice before and it does > provide some relief. For how long? That is something that no one can > predict and with the problems that I already have, there could be no > improvement at all. > > The results of the MRI were reviewed by two orthopedic surgeons at > my request. > > The opinion that I was most interested in is that of my former > orthopedic surgeon -- the one who did all of the previous surgeries on the > knees. His first response was that he was surprised that my knees had held > up as long as they did. When he wrote his P & S statement for Federal Work > Compensation he stated that a TJR would be required within five to eight > years. He also noted that there had been no indications of RA or Lupus SLE > the entire time that he was treating me, a period of four years. His > treatment recommendations were that no surgery be performed right away, but > that Synvisc or similar injections be tried first. If I get good results > from those injections, then the TJR can be postponed. He noted that the > damage from the lack of cartilage is surprisingly low and that the knees > appear to have been damaged more by the inflammation processes that have > occurred since he last saw me. He stated that there is really nothing more > that could be tried after the Synvisc other than implanting an artificial > cartilage in each knee, but also noted the various problems that a foreign > body would pose for me in light of a compromised immune system. > > The second orthopedic surgeon is the one to whom I will be referred > if the Synvisc injections do not bring relief. He noted that the cartilage > in the left knee has been repaired, but that the blood source had been > removed through the waxing and waning of the inflammatory disease process, > both degenerative arthritis and Rheumatoid Arthritis could have brought that > about. He also recommended that Synvisc be tried in hopes of delaying > further invasive treatment; however, he does not feel that a failure with > Synvisc should be followed with the implantation of artificial cartilage > because my immune system attacks healthy parts of the body and the presence > of a foreign material could trigger a larger problem that could involve more > than just the knees. If the Synvisc does not work, he recommends > debridement of the two knees on an inpatient basis in order to monitor my > response afterward -- any sign of infection would have to be aggressively > attacked with both antibiotics and other medications to slow down the immune > system (i.e.. chemotherapy such as is used for cancer treatment). He > recommends that both an immunologist and an oncologist begin assessing > tissue samples to find the drugs and other agents best suited to combat > possible side affects, or infection, or massive immune system response. > > My PCP started the process today with my primary and secondary > insurance carriers to gain approval to use the Synvisc; however, he went > further and indicated that he wanted " Direct Admission Authority " in the > event of reaction to the hospital in Lake Havasu City, where my orthopedic > surgeon is on staff. The hospital also has a immunologist, Rheumatologist, > and oncologist on staff, all of whom might be needed if my immune system > decides to go haywire in response to the injections. The literature does > not make mention of the responses in patients who have immune system > problems, but when he contacted the manufacturer, the doctors on staff > stated that there had only been two cases of " immediate medical risk > situation " to the injections, both of which required hospitalization. Both > of those cases were treated, the injections curtailed, and the patients had > no further adverse affects. He was not aware of what occurred in follow-up > with regard to subsequent treatment of their knees. > > As my doctor put it, " This is really a report about what a mess your > knees are! " . So, I will try the Synvisc. If it is successful, then I " wait > and see " how long the relief lasts. It could be a matter of weeks, > months -- no one really knows. The next step after that would be to either > redo the Synvisc or proceed directly to the debridement procedures. If the > debridement is not successful in relieving the pain and instability, then I > proceed to replacement of the knees. > > While it isn't all good news, it isn't all bad either. In the end, > the knees will be replaced, but it is hoped that the surgery can be delayed > long enough for me to do three things: get relief from the interim > procedures, lose enough weight to make the rehab easier on me, and get in > good enough physical shape to be able to deal with the surgeries when they > are done. > > I have some work ahead of me. I am determined to do what I can to > delay the TJRs, so I had better get busy! > > Dianne > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 26, 2002 Report Share Posted November 26, 2002 ----- Original Message ----- From: " a " <paula54@...> Dianne, The Synvisc has helped to delay replacements, so I hope you are one that benefits from it. I had the debridment done before getting mine replaced and it gave me a few additional years. It¹s good that you have options to hopefully delay replacements until you have no choice. a > Hi, Everyone, > > My MRI report was presented to me today. The news is " mixed " . > > The immediate observation was that both knees were loaded with scar > tissue, but not all of it was due to the earlier surgeries. Arthritis > inflammation in the joints has caused a lot of scarring. What to do? There > were some suggestions. I could have the joints " debrided " , which would be > done with an arthroscope, which would involve removing the inflamed tissue > and the scarring. I have had that procedure twice before and it does > provide some relief. For how long? That is something that no one can > predict and with the problems that I already have, there could be no > improvement at all. > > The results of the MRI were reviewed by two orthopedic surgeons at > my request. > > The opinion that I was most interested in is that of my former > orthopedic surgeon -- the one who did all of the previous surgeries on the > knees. His first response was that he was surprised that my knees had held > up as long as they did. When he wrote his P & S statement for Federal Work > Compensation he stated that a TJR would be required within five to eight > years. He also noted that there had been no indications of RA or Lupus SLE > the entire time that he was treating me, a period of four years. His > treatment recommendations were that no surgery be performed right away, but > that Synvisc or similar injections be tried first. If I get good results > from those injections, then the TJR can be postponed. He noted that the > damage from the lack of cartilage is surprisingly low and that the knees > appear to have been damaged more by the inflammation processes that have > occurred since he last saw me. He stated that there is really nothing more > that could be tried after the Synvisc other than implanting an artificial > cartilage in each knee, but also noted the various problems that a foreign > body would pose for me in light of a compromised immune system. > > The second orthopedic surgeon is the one to whom I will be referred > if the Synvisc injections do not bring relief. He noted that the cartilage > in the left knee has been repaired, but that the blood source had been > removed through the waxing and waning of the inflammatory disease process, > both degenerative arthritis and Rheumatoid Arthritis could have brought that > about. He also recommended that Synvisc be tried in hopes of delaying > further invasive treatment; however, he does not feel that a failure with > Synvisc should be followed with the implantation of artificial cartilage > because my immune system attacks healthy parts of the body and the presence > of a foreign material could trigger a larger problem that could involve more > than just the knees. If the Synvisc does not work, he recommends > debridement of the two knees on an inpatient basis in order to monitor my > response afterward -- any sign of infection would have to be aggressively > attacked with both antibiotics and other medications to slow down the immune > system (i.e.. chemotherapy such as is used for cancer treatment). He > recommends that both an immunologist and an oncologist begin assessing > tissue samples to find the drugs and other agents best suited to combat > possible side affects, or infection, or massive immune system response. > > My PCP started the process today with my primary and secondary > insurance carriers to gain approval to use the Synvisc; however, he went > further and indicated that he wanted " Direct Admission Authority " in the > event of reaction to the hospital in Lake Havasu City, where my orthopedic > surgeon is on staff. The hospital also has a immunologist, Rheumatologist, > and oncologist on staff, all of whom might be needed if my immune system > decides to go haywire in response to the injections. The literature does > not make mention of the responses in patients who have immune system > problems, but when he contacted the manufacturer, the doctors on staff > stated that there had only been two cases of " immediate medical risk > situation " to the injections, both of which required hospitalization. Both > of those cases were treated, the injections curtailed, and the patients had > no further adverse affects. He was not aware of what occurred in follow-up > with regard to subsequent treatment of their knees. > > As my doctor put it, " This is really a report about what a mess your > knees are! " . So, I will try the Synvisc. If it is successful, then I " wait > and see " how long the relief lasts. It could be a matter of weeks, > months -- no one really knows. The next step after that would be to either > redo the Synvisc or proceed directly to the debridement procedures. If the > debridement is not successful in relieving the pain and instability, then I > proceed to replacement of the knees. > > While it isn't all good news, it isn't all bad either. In the end, > the knees will be replaced, but it is hoped that the surgery can be delayed > long enough for me to do three things: get relief from the interim > procedures, lose enough weight to make the rehab easier on me, and get in > good enough physical shape to be able to deal with the surgeries when they > are done. > > I have some work ahead of me. I am determined to do what I can to > delay the TJRs, so I had better get busy! > > Dianne > > > > > > > Quote Link to comment Share on other sites More sharing options...
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