Surgeon vs. Knee Maker: Who’s Rejecting Whom? (attn: bionic boomers-knees,hips)

NY Times ^ | 6-20-10 | Barry Meier

[STARWISE]

IT was a long, fruitful medical marriage that is fast becoming an angry public divorce, one that offers a rare look at a clash between a top-shelf consultant and his corporate patron over patient safety.

*snip*

In return, Zimmer, an orthopedic implant maker, helped enrich Dr. Berger, portraying him as a master surgeon and paying him more than $8 million over a decade.

Those days are gone. Dr. Berger started complaining to Zimmer a while back that one of its artificial-knee models was failing prematurely, and he went public recently with a study that he says proves it.

[Ceebass]

It basically came down to exercise, stretching, and ice packs.

If I don’t do at least 15 minutes a day 5 times a week on my lifecycle I get pain and swelling. Am taking 200mg of celebrex 2x a day. If I forget a dose, that’s not good either.

[STARWISE]

Amazing .. I’ve never heard of that kind
of transplant.

I see here they’re doing that with cadaver
cartilege implantation.

http://www.kneepaininfo.com/oaCartilageTransplant.html

I’m praying for further advances and perfection
of a similar procedure for folks with no cartilege
from arthritis damage as is my case in my unrepaired
knee. Not holding out much hope, tho.

[STARWISE]

That’s a long time and great discipline for
that kind of peak pain endurance. Very tough.
I’m scared of Celebrex .. it’s in the same class
of painkillers as Vioxx, which was my precious
manna from heaven. It was miraculous.

Once the FDA removed that for the strokes, heart
attacks, I got scared off Celebrex. I have to be
in agony to take any pain med.

I take at least 4K IU of Omega 3 Fish oil/day,
and walk a few times a week, but I think the
fish oil keeps some lubrication in that wrecked
joint .. and I just pray it lasts as long as I
do .. ;).

[Natural Born 54]

My husband had a hip replacement in Feb. of this year. It was a great success as he has no more pain there. Unfortunately, he is now realizes how painful both knees are without the hip hurting. We know he should have both knee joints replaced as soon as possible. There is almost no cartilage left in either joint.

I injured one knee years ago and re-injured it while carrying heavy wood up and down several steps bringing it into the house to the wood stove while he was recovering from the hip operation. So, bottom line, this family is looking at 3 knee replacements.

The hip thing was a tough experience all around as I am sure many of you know who have had replacement done. While I am grateful that there is an alternative to ending up immobile or crippled with limited mobility, I was very unhappy contemplating what lies ahead. So, I did a bunch of research one night, including looking through the health category at gizmag.com. (If you want to keep up with what’s going on in high tech, health - everything, read the updates regularly at that web site.)

What I stumbled onto will give all of you who have joint problems and still have your own parts some really good news. Cartilage regeneration has been elusive in medical research up until this year. NW Univ. announced a major success in animal experiments with a new substance they invented. I found the info on the university web site here:

Growing Cartilage — No Easy Task
New nanoscopic material enables cartilage to do what it doesn’t do naturally
http://www.northwestern.edu/newscenter/stories/2010/02/cartilage.html

Summnary:

1. It’s an injection
2. It takes 30 days to grow new cartilage
3. It is natural material and non-toxic (biodegradable nutrient soup that acts as a catalyst prompting your own body to grow its own cartilage)
4. It will be very inexpensive compared to replacements
5. NW Univ. announced it in Feb. and was heading into trials right away. Since it is non-toxic, one could reasonably hope for a fast track from the FDA
6. The savings versus replacements... I saw a figure of over a billion for medicare annually (data was pre obama)

We printed the articles out and brought them, at her request, to our surgeon. She doesn’t have a problem with the new procedure cutting into her practice as there is plenty of work left to take up the slack. We are watching for results and she is also so we shouldn’t miss it when it is available for humans.

Tell everybody you know that’s facing replacements due to cartilage being damaged. This is a big deal!

[Natural Born 54]

I should mention that our surgeon was very impressed with the information we took to her and what she discovered when she investigated it. This really looks like a hugely important development. Of course, not all joint problems are cartilage related, but lots of them are with knees. I’d like to get the info widely distributed - I posted it here when I found it but who knows how many people saw it? Is there a ping list for health subjects? Anyone looking at having a knee replacement done should seriously consider waiting for this. Also, I wish I had the ability to find out how long it will be before it is available to the public. Maybe someone here has the contacts to be able to do that?

[Darnright]

Thanks for posting this. A family member is looking at a replacement in the near future.

[STARWISE]

Very interesting developments .. thank you.
Will look into it.

[Chief Engineer]

Maybe I should be grateful the hip replacement I had done here in Canada involved a 7 1/2 inch incision because of my severe osteoporosis. They had to make a big incision to clear out all of the shattered bone after me just bumping a plastic door jamb! I wonder what they will do with the shoulder which I was originally told would be a shoulder joint replacement but now is a total shoulder replacement! I’ve only been waiting since October for that and I doubt I will be fortunate enough to receive the surgery for at least two years. They will also have to send me out of province for which I consider myself lucky since the hospital I have been dealing with is the most corrupt hospital I have ever had the misfortune of being a patient at! Obamacare HAS to be reversed or many in the U.S. will end up going through the horrors I have faced since June of 2009. Starwise I will be sending you a private post or Freepmail tomorrow to fill you in and update you on various matters, don’t mean to hijack your thread.
I do agree with the one poster who suggested tramadol as a pain relief for bedtime.

[grey_whiskers]

Like, *PING*, dudes and dude-ettes.

Cheers!

[lonestar]

My cousin had a knee replacement, got a staph infection in his knee, they had to take it out and he was without a knee for several months while the staph was treated.

[wintertime]

Thank you for your advice. I will call my surgeon's PA and talk to him about some alternatives.

Starwise,...Wow!... A blood clot to the lung. What a scary time for you. After reading your post, I said an extra prayer of gratitude that everything has gone so well with my surgery. I hope you are fully recovered from your knee surgery and the blot to the lung.

[Grampa Dave]

Re the narcotic pain pills, I had a rotor reuter job on my right knee last August.

My orthopod wrote an RX for 60 Norco 10mg/325 tabs with a refill. With a sig of 1-2 tabs every 4 hours.

I took eight tabs in total. The discharge RN gave me one before I left the hospital, and I took another one that night. Then, I went on a half tab a couple of times a day. My FP told the Ortho that neither my wife nor I do well with narcotics. She gets severely nauseated and I get weirder and with no pain relief. I ended up with a week of Toradol tabs 3 times a day. Then, I went on Alieve liquid caps twice a day.

[MS.BEHAVIN]

To be honest, I’m not sure if I want to watch it!

[STARWISE]

Very, very scary for sure. Yes, be grateful.
I sure am, praise Jesus. I probably would’ve
died, had it happened in my sleep, and that’s
why I’m so reluctant to go thru it again and
am mostly accepting of the misery the bad knee
gives me .. it’s twice as big as the fixed one.

I’m pretty certain I know why it happened. I’ve
been taking baby aspirin, Vit C, Vit E, Omega3
Fish Oil and a small glass of red wine daily for
years.

The doc told me I had to get off all those 10
days before surgery. I had strong resistance to
doing that, and did a bit of research.

I found a study published in the UK med journal,
Lancet, that showed the risk of getting a clot
or stroke during joint surgery by stopping baby
aspirin before was HIGHER than the risk of overbleeding
during surgery .. I gave him the study.

My son’s a doc, and when I showed him the study,
he not only agreed with it, but said the conclusion
was that you’re crazy if you’re NOT taking daily
baby aspirin.

My surgeon said it was ‘controversial,’ and that
I’d be risking paralysis or compromise the epidural
anesthesia’s effectiveness, if the injection site
bled.

What choice did I have .. he terrified me?

But I believe the cold turkey stoppage of the above
shocked my body, and suddenly and dramatically altered
the chemistry of my blood .. and it thickened up and
allowed the clot. While some bodies certainly
tolerate that stoppage fine, every body is different
and reacts differently to dramatic changes.

So, it’s a dang Catch-22.

FYI .. here’s that study:

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

***Aspirin Prevents Serious Complications From Surgery
By Elaine Zablocki
WebMD Medical News
###

Excerpt:

April 13, 2000 (Eugene, Ore.) — Small doses of ordinary aspirin may help decrease complications in people who go through major hip or knee surgery, according to a large study just published in the April 15 issue of the journal Lancet.

Two of the main complications of major surgery are deep-vein thrombosis or pulmonary embolism. A deep-vein thrombosis is a blood clot that forms in the blood vessels of the legs.

If a clot breaks loose, it can travel upward, creating a blockage in the lung called a pulmonary embolism. An embolism is a serious condition that can lead to death. A thrombosis or embolism can occur weeks or even months after surgery.

Thrombosis and embolism are treated with certain medications that break up blood clots or prevent more clots from forming. These same medications can often be used to prevent them as well. Researchers examined whether aspirin could be used in patients undergoing hip and knee surgery to prevent these dangerous complications.

“In the past, there has been uncertainty whether aspirin would prevent this type of clot,” says Anthony Rodgers, MD, lead author of the article. “The key advantage of aspirin is that it is easy to take, and its side effects are well known.” Rodgers is with the University of Auckland in New Zealand.

Researchers looked at more than 17,000 people who were having surgery for hip fracture or hip or knee replacements.

Half of them got low dose aspirin each day, starting before their operation and continuing for 35 days. The other half got placebo pills that looked just the same.

When they tallied up the results, the difference was striking.

Among patients with hip fracture, aspirin reduced the risk of an embolism by 43% and the risk of thrombosis by 29%. The effects of aspirin on patients having hip or knee replacements were similar. Based on his results, Rodgers urges physicians to consider that aspirin may be of benefit in other types of major surgeries or illnesses that increase the risk for blood clots.

http://www.webmd.com/news/20000413/aspirin-prevents-serious-complications-from-surgery

[Grampa Dave]

When I had my knee operated on, my orthopod and anesthesiologist said to stay on the baby aspirin and to take it the night before and the morning of the operation.

They,also, wanted me to take a baby asprin and my Vasotec the morning before the operation.

A couple of weeks before my knee operation, I had my second cataract surgery. I was having fairly severe pain with my knee, and it was causing some back spasms. The last thing I and the eye surgeon needed was me to have a spasm as he was slicing and dicing my right eye to remove the cataract and to replace it with the new Accommodating Lens.

There was a discussion with the Orthopod, Anes. and Eye Doc.
We put a Flector,(diclofenac/Voltaren patch on the knee the night before and the next morning. I had a disposable heat patch on my back the night before and in the morning before the operation. The back patch was replaced with a Flector Patch post op. I, also, got 5 mg of Valium po/by mouth about an hour before the operation to minimize any spasms. After the eye doc finished putting in the new Accomodating Lens, the Anes. gave me an extra little Versed. I was very relaxed and went to sleep on the way back to recovery.

[LucyT]

Surgeon vs. Knee Maker: Who’s Rejecting Whom? (attn: bionic boomers-knees,hips)

Article, and also Check out # 24.

[Thanks, grey_whiskers.]

[KYGrandma]

I have no cartilage under my kneecaps. Couldn’t walk up stairs. Had the Hyalgan injections. Amazing results. If it weren’t for the leg I broke in Jan. I would be back to normal.

[STARWISE]

Wish I’d had a doctor like yours.
Very complicated journey you were on.
Glad you found the remedies that worked.
It’s a minefield .. aspirin, prescription
rx’s, painkillers and conscientious, savvy,
and trustworthy medical professionals.

Personal research and due diligence are
key. God’s mercy is my constant prayer.

[raygun]

I reiterate my suggestion: talk to your pharmacist (not the surgeon's PA). Pharmacists know about drugs. They studied nothing but drugs. They know how they work, interact and postulate synergistic affect. Let them know ALL of the medications you're currently taking. Ask for their recommendation concerning an alternative to hydrocodone (LorTab) so that you don't need to supplement with Tylenol. That's your objective: not to take Tylenol.

Make the suggestion you'd like to use OTC ibuprofin / naproxin sodium (either individually or in conjunction) with either propoxyphene, Tramadol or perhaps extended release Oxymorphone (Opana, Numorphan, Numorphone) as an alternative to LorTab. Opana extended release has been shown to have significant analgesic affect for as long as 36 hours. Don't forget to mention the NSAID analgesics Feldene, Mobic or Lornoxi as alternatives for, or adjuncts to, either, ibuprofin, naprosin, or both.

The problem I see is that propoxyphene may not be strong enough, but all the hydrocodone equivalents belong in the opiate category are significantly more potent (and carry the associated significant risk of addiction with them). However, propoxyphen may be suitable if used in conjunction with the OTC NSAID analgesics that I mentioned.

IF the objective of the pain management regime works, i.e., manages your pain througout the day, you may not even need stronger opiates. IF the purpose of the opiate at night is for its sedative affect, then try an OTC sleep-aid, e.g., melatonin, trptophan, GABA, et ali. In fact, ostensibly for that putative purpose alone GABA is highly suggested, i.e., GABA participates in promoting relaxation, which allows one to sleep. Unlike many relaxants, it does not cause drowsiness, just easing anxiety. As a natural stress-reducer, GABA supplements may help support pain reduction. They may also lessen pain-related nerve impulses. For the brain and neural health, GABA appears to inhibit nerve cells in the brain from firing haphazardly.

Given all the options, that's why I believe the pharmacist should make the recommendation; doctors are not trained in pharmaceuticals or pharmacology; they work from a standard script (based on their training, experience and what the drug reps tell 'em). Ultimately, if the doc don't want to work with you on this: find a different doc. Your doc can't reject a reasonable request from you, i.e., one not predicated on addictive drug-seeking.

Moreover, I'd highly recommend a daily intake of 500mg to 1000mg daily of Vit C to facilitate recupteration and healing. It is essential for the production of collagen, i.e., connective tissue.

All the foregoing notwithstanding, I'm not a doctor, nor pharmacist; I don't play one on TV and havn't stayed in a Holiday Inn Express either. I offer some suggestions that you should take up with your health care providers, i.e., pharmacist most especially and final approval by your physician(s).

[Miztiki]

Vit C helps with collagen?

I have OI type 1 (connective tissue disorder I inherited) causing a collagen deficiency, making my bones osteoporotic (sp), my joints weak, my muscles fairly flaccid, and I get fairly easy bruising too. Bad bones are the worst though.

I’ve seen countless specialists over the years (UofM, Duke, Texas Children’s Hospital (yes, I was an adult patient there)) and no one has ever mentioned vitamin C to me.

I’ll check it out though, so thanks for the tip!