Update on Dianne

[Guest guest]

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