Surgeon vs. Knee Maker: Who’s Rejecting Whom? (attn: bionic boomers-knees,hips)
Article, and also Check out # 24.
[Thanks, grey_whiskers.]
Posted on 06/20/2010 7:23:02 PM PDT by 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.
(Excerpt) Read more at nytimes.com ...
~~Ping!
Not even close to Frontpage..
My first knee replacement, an Oxford unicompartmental, failed after 9 months. Now I have a total revision replacement in its place. Its been 15 months since I received it and it’s still giving me problems.
A brand of artificial knees and hips,
which procedures are not uncommon in
the FReeper population ... failing ?
Interesting.
Interesting article. I had my cartilage removed in my right knee 40 yrs ago. I am now 62 and beginning to feel pain. I have spoken to numerous people who advised me to have the knee replaced. I will be speaking to my orthopedic surgeon when he sees me and show him this article for his opinion. Will let you all know later what he says.
Yes, do. I had a replacement just over 2
yrs ago .. I’m calling my surgeon tomorrow
to find out the brand. Since he was trained
by Berger, I’m a bit uneasy.
I had both knees replaced last March 17th. Wow! What a recovery!
At three months it is still very painful to get out of a chair or go up or down the stairs. By evening, I feel like elephants are crushing my thighs. Yet...The physical therapist, the surgeon, and his physician’s assistant tell me that I am ahead of the curve in healing and rehabilitation. I can’t imagine what it would be like to be behind the curve.
If I had to have this procedure redone, I think I would go completely NUTZ!
One thing the doctor was not exactly truthful about was pain management. They want the patients off all narcotics by 3 months, Except for a lortab just before bed, I am off the narcotics, but honestly Tylenol and Advil just aren’t up to the job in the day time.
Also...The doctor failed to inform me about how uncomfortable it is to get off the narcotics. Fast or gradual, it stinks. I did it fast ( about 6 weeks ago) and the process took about a week. I thought my eyeballs would melt and drip down my face. The experience was everything anyone might have seen in a movie about heroine withdraw. Now its tylenol and Advil during the day and one lortab at night, and believe me, it isn’t enough to control the discomfort.
WOW .. getting both done at the same time
is tough. I could not have handled that ..
as it is, I’m lucky to be alive. Got a
blood clot in my lung the next day .. thank
God I was awake and felt so breathless I
knew something was wrong and yelled for
help.
My D-I-L’s colleague had the same surgery
the same week. She just never woke up ..
died from the clot.
Prayers that you find relief soon .. I surely
empathize with you. I sure would be on that
doc’s doorsteps frequently to push him til he
thoroughly checks what’s happening with the
healing process and pain level after this amount
of time.
Have you tried Aleve? You may have to eat three (or four) every 6 - 8 hours for a day. Then one every twelve hours thereafter.
Aleve is OTC naprosyn (naproxin sodium). They came in horse pill sizes (up to 1g ea.) equivalent to 4 Aleve tablets).
Make sure to take ‘em on a full stomach though. Iboprufin doesn’t have stomach irritation like aspirin, but naproxin sodium can cause gastrointestinal disturbance in large doses. Acetaminephen is extremely hard on the liver. If you drink any alcohol whatsoever, you’re damaging your liver. Its as simple as that. How serious is the damage, perhaps minimal and the organ can repair itself over time.
My advice: stop taking the acetaminephen.
Ask your pharmacist what they’d recommend concerning dosage of ibuprofin & naproxin sodium combined. That may take the edge off.
Also, during the day you may want to consider taking a No-Doze with your pills. Caffeine has a synergistic affect on analgesics. That’s the whole point of caffeine in Excedrin.
My wife had one done last summer. The first few months were pretty bad, but it took 3 1/2 months before she could sleep through the night, and after 4 or 5 months she finally started to feel better off than before the surgery.
They never give you enough narcotics. Knee replacements are painful!
*sigh*
Great.
I will have to have my knee replaced in the near future..
Thanks for posting this, I’ll do some homewok!
My husband is having his knee scoped again in 9 days. This will be his 9th. The doctor told him he was a good candidate for knee replacement.
He’s not yet 50 and refuses to even consider it. He deals with constant pain and does not use narcotics.
I am sending this atricle to him tomorrow. Thank you for posting it.
O.K., I know why they’ve got you on the aceteminaphen. It works synergistically with the hydrocodone you’re taking (akin to caffeine and NSAIDs).
Talk to your pharmacist concerning his recommendation as to a suitable alternative to the hydrocodone so you don’t have to take the aceteminaphin as an adjunct. Perhaps propoxyphene or tramadol? Whatever the pharmacist suggests, go back to your surgeon and ask for a prescription for that.
Maybe the’ll entertain the idea of subsituting Feldene, Mobic or Lornoxi for the ibuprofin? Perhaps that, or Aleve / (Motrin or Advil) combo will work better in conjunction with either propoxyphene or tramadol at night.
Oh .. I’m so sorry, Ms B. By all means,
do your homework .. make that doc give
it all up .. the company, the model .. all
of it. We have to be our own research
and analysis team these days. And God knows
what obamacare will be like in the future.
Prayers sure sent up for a skilled medical
team and best choices for great relief and
healing. God bless you.
____________________________________________________________
Ob-Gyn Practice Closes, 5K Left Stranded
Practice Will Remain Open While Staff Notifies Patients
UPDATED: 7:53 pm EDT June 18, 2010
###
More than 5,000 patients are looking for a new ob-gyn practice after one suddenly closes its doors in Norwich.
The sudden decision to close Norwich Ob-Gyn on Otrobondo Avenue was a personal one and financial reality for Dr. John Bowdin. On Friday, his staff was busy notifying all the patients of the decision.
“I’m nervous. It’s scary being 16 weeks pregnant and not having an ob-gyn,” said Nicole Rechney.
The reason for the closure, according to Bowdin, was that the numbers weren’t adding up. The insurance payments from the state patients, and the lack of insured patients didn’t add up.
Bowdin said, “We had to shut down until we find out from the state health department and ethics what we should do.”
In practice for 40 years, Bowdin said some of his employees have already found jobs and his patients are connecting with other ob-gyns in the area.
Worried patients like Megan Carlson don’t know what to do. “I’m just so upset,” said Carlson. “I can’t believe they didn’t call. I came to get medical records. It’s awful.”
As the phone calls go out with the unsettling news, patients with critical care needs were being advised to head to the nearest emergency room.
Norwich Ob-Gyn will remain open for the next several weeks while the staff makes sure patients are aware of the closure and able to find proper care.
http://www.wfsb.com/health/23958416/detail.html
________________________________________________
Medicare changes hit close to home
Dr. Gary Berliner
May 25, 2010
###
Some patients forced to find different doctors
by Sudie Crouch
###
Bill McClellan of Dawsonville went to his doctor last week for a follow up about some cancerous cells he had previously had removed. What he saw posted in the window shocked him more than any diagnosis ever could. A note was hanging, advising the patients of Dr. Gary Berliner that, due to current changes in Medicare, Berliner’s Chestatee Emergent Medical Care center would no longer see Medicare patients effective June 1.
The notice read: “As of June 1, 2010, Medicare reimbursement will be cut by another 21.5 percent, which will necessitate our office no longer accepting this program coverage.
If Medicaid and Tricare follow these proposed Medicare cuts in reimbursement, then we will be forced to discontinue their coverage as well. However, we will continue to see all patients on a self-pay basis.”
The decision to no longer accept Medicare has been one wrought with emotion for both patient and doctor.
http://www.dawsonadvertiser.com/articles/2010/05/27/news/news05.txt
____________________________________________________
Friday, June 9, 2000
Frustrated doctors are leaving medicine behind
http://www.bizjournals.com/atlanta/stories/2000/06/12/story8.html
Bump
He’s brave ... sure hope a good
option awaits him, and you’re
welcome.
My gosh .. what a shame. What’s your
doc’s solution.
I wound up with a meniscus allograft - a cadaver transplant - on my 4th scope. They find a complete meniscus that is a close match for size and geometry, and its anchored in with bone plugs (so it’s like having to heal up a broken leg as well as deal with a scope). Blood-type match, so very little chance of rejection.
Took about 16 months to get back to pre-injury level of pain, but it was worth it.
Check out this website. It shows you in graphic terms what knee replacement surgery is all about.
http://www.edheads.org/activities/knee/index.htm
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.
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.
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 .. ;).
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!
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?
Thanks for posting this. A family member is looking at a replacement in the near future.
Very interesting developments .. thank you.
Will look into it.
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.
Cheers!
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.
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.
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.
To be honest, I’m not sure if I want to watch it!
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
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.
Surgeon vs. Knee Maker: Who’s Rejecting Whom? (attn: bionic boomers-knees,hips)
Article, and also Check out # 24.
[Thanks, grey_whiskers.]
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.
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.
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).
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!
The vitamin C has to be the real thing, from fruit, to do any good. All that synthesized C does is loosen your bowels.
When you get into Vit C you're entering the arena of nutrition and homeopathic medicine. Do you know what the academic requirements for a docter are pertaining to nutrition? One college course amounting to no more than 10 contact hours. And they probably take that in pre-med.
The one thing to be totally aware of when following a megadose Vit C regimin: hydration, hydration, hydration. Normal hydration means consumption of sufficient water to generate at least 1 qt of uring per day. That doesn't include diuretics such as coffee, tea, beer, etc. The fact is most people are significantly dehydrated and don't know it.
When following a megadose Vit C regimin one should double their fluid intake. Anything in excess of 1g daily is considered megadose. Short term megadosing shouldn't have any long term complications to health. However, if one has any sort of renal failure, or ever has had kidney stones (or familial history thereof) the subject should be discussed with their specialist. Its long-term megadose Vit C intake that requires attention. Risks 'associated' with megadose Vit C intake can be mitigated by balancing intake with B-complex and niacin (among other minerals). Most such risk is trivial, unless one has predisposing factors that warrant concern. You want to look into the link between oxalic acid, kidney stones and Vit. C. By minimizing the former, the stone issue is significantly mitigated (for normal healthy individuals non-disposed to renal deficiency or diseases).
Vit C is highly recommended with respect to immune boosting, and as prophalaxis concerning stress and trauma of any sort. Surgery definitely qualifies as trauma. Furthermore, trauma induces stress - release of prostaglandins - and the associated insiduous affect of inflamation; also stress is deletrious to properly functioning immune system.
One needs to fortify their diet with extra amounts of dark leafy green vegetables and fiber when undertaking high Vit C intake. 40 g fiber daily should be the healthy daily target for everybody; most especially with regards to high intake Vit C. The single most recognizable symptom of Vit C overdose, per se, is a loose stool. The cure: back off the dose a couple hundred mg (one's stool should firm right up within hours). Also, never take more than 250mg at one time. Stagger doeses equally throughout the day. However, if one consumes sufficient roughage they may never notice this (and be able to consume massive quantities of it without side-effect). Secondly, the vitamins inherent to vegetables that one consumes to meet the fiber requirement should be sufficient to balance high Vit C intake without having to resort to supplements to balance the Vit C.
In the short term - without predisposing factors - there's not much to worry about (its the long-term yearly high Vit C intake that requires special attention). For example: several grams daily Vit C for years.
The Cartilage Transplant procedure sounds very similar to the meniscus allograft. Could it be only a partial (doesn’t make sense - if it’s that far gone, then a total replacement would be in order rather than just a partial)?
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