Posted on 12/11/2008 2:46:11 AM PST by neverdem
Cheryl Weinstein’s left knee bothered her for years, but when it started clicking and hurting when she straightened it, she told her internist that something was definitely wrong.
But in many cases it is just not known whether what is seen on a scan is the cause of the pain. The problem is that all too often, no one knows what is normal...
--snip--
As a rheumatologist, Dr. Felson saw patient after patient with knee pain, many of whom had already had scans. And he was becoming concerned about their findings.
Often, a scan would show that a person with arthritis had a torn meniscus, cartilage that stabilizes the knee. And often the result was surgery — orthopedic surgeons do more meniscus surgery than any other operation. But, Dr. Felson wondered, was the torn cartilage an injury causing pain or was the arthritis causing pain and the tear a consequence of arthritis?
That led Dr. Felson and his colleagues to do the first and so far the only large study of knees, asking what is normal. It involved M.R.I.Dr. scan is not necessarily desirable, said Dr. Scott Gazelle, director of radiology there.
“The consensus is that you are a surgical candidate or not based on your history and physical findings, not on imaging findings,” he said.
Dr. Gazelle went to see his primary-care doctor but, he said, “I didn’t get an M.R.I.” That decision, he added, “was the right thing to do.”
About three months later, he had recovered on his own.
(Excerpt) Read more at nytimes.com ...
Well that's her problem right there: You never EVER EVER go to see a generalist about a problem which should be handled by a specialist.
In her case, if she had a problem with her knee, then she should have gone straight to an orthopedic surgeon who specialized in Total Knee Replacements [TKRs].
Seeing anyone else was, at best, a complete waste of her time - at worst, it could have set her back years in learning the true nature of her problem.
It’s about time a study was done on the general population. Too often studies (in all fields) are done only on young collage students. I seriously doubt my 62 year old joints have much in common with an 18 year old.
We’re big believers in second opinions. A couple of years ago, my husband had severe knee pain. The first orthopedic specialist diagnosed spontaneous osteonecrosis, and said the knee would probably need to be replaced. He prescribed a brace and crutches for a few months, since there was a 10-15% chance it would resolve. We sought a second opinion, and did extensive research to find a regional specialist on osteonecrosis. He came back with a totally different diagnosis, saying that it was bone marrow edema, and that with rest, it should heal in 12-18 months. He spent a long time on crutches, but indeed, it healed without surgery. Had he instead gone for surgery, we would never have known that he was mis-diagnosed, and he’d have been worried about whether other joints would be similarly affected in the future. Even good doctors can make mistakes, especially if they have limited experience with a particular problem.
In many or most insurance plans, with the exception of expensive gold-level BCBS, an insured patient does not have the option of going straight to an orthopedic surgeon. One must be triaged first by going to one's PCP who is usually a family practice guy or an internist. Only if he gives a referral to the specialist is your care from the specialist covered. Go to the ortho for a $200 office visit and a $4000 MRI without the referral, and it's right out of your pocket. That process slows a lot of people down.
Obamacare, here we come.
Right. Thereby pretty much guaranteeing a total knee replacement whether you needed one or not. /sarc
I love it when patients try to pick the proper specialist to go to. “I’m dizzy, I want to see a neurologist”. When the problem is a cardiac arrythmia. “I’m short of breath I want a referral to a Pulmonologist” when they need emergent Cardiac bypass for their coronary disease. I see this stuff over and over and over.
We’ve seen this before with CT of the spine. LOTS of people get a CT are told they have a “bulging disc”. The problem is we see just as many of those bulging discs in patients who don’t have back pain as those who do, so that in many cases, operating on the disc will NOT get rid of their back pain and in fact may make it worse.
This story brings up the knee surgery fraud from a 2002. Arthroscopic knee surgery for arthritis – a procedure performed hundreds of thousands of times a year and a main source of income for orthopedists was found to be ineffective.
When they did a sham procedure on one group of patients in which they only made an incision in the knee versus the other group of patients who actually had the surgery, guess which group did better?
The placebo group. Insurance companies and us policy holders have been paying orthopedists for years for a procedure that is quackery.
The kicker is that despite the NEJM study results, orthopedist nationwide continued to perform the worthless procedure in spite of the knowledge.
http://www.time.com/time/health/article/0,8599,1840470,00.html
Isn't that the truth.
A not-so-bulging disc was causing major sciatica down my left leg, but the disc that looked like a flat tire on the scan wasn't bothering me at all.
There are so many tiny mechanics involved in spinal function that can go wrong...at least new treatments are on the way. My back is killing me but I'm not going to undergo a 3-disc fusion. Nuh-uh, won't do it. A 50% success rate isn't good enough and I can wait.
Speaking about insurance, BCBS just stopped paying for the discectomy I had last spring. They said it had a low success rate. I did, however, get rid of the sciatica, which is a huge relief.
I, OTOH, rupture my disk Christmas of 1990. I went to the doc in early January and he prescribed bed rest and pain killers. He said to move about as I could but to follow the conservative treatment route. So, I did. I managed. And that was all he did for a long time. Finally, in ‘97 I got tired of managing, the pain was much more intense although I was managing my life around it, and I switched doctors. This new doctor did operate, a laminectomy on my L5, and I spent about a year recovering and healing.
Today, 11 years after the surgery, I am pain free. I can move about and bend and twist with no problem. I do resent those 7 years prior to the surgery when I “managed” and suffered.
I also resent the attitude toward pain killers that many docs have. But that is another gripe.
Medicine is an art, not a science. In some instances it’s pure science, but when it comes to the myriad of things that can make someone hurt it’s really an art and a difficult one to master at that.
I liken the problem to cars and mechanics. Ford builds a particular model of a car and produces several hundred thousand of them, all identical for all intents and purposes. Turn the clock ahead a couple of years and a lot of those cars are having problems. Take one of them to 10 mechanics and likely as not you’ll get 12 or 13 different ideas as to what’s wrong. Now compare those hundred thousand cars, all built exactly the same, with the human body and its unlimited variety of individual conditions. Is it any wonder doctors have a hard time figuring out what ails some people. Throw in a significant proportion of the population that gets some benefit from being sick or injured and you’ve got a real problem. And that’s where we are.
I have just had a total hip replacement. Couldn’t be happier. It’s been under a month and I’m back to normal in most every manner. Others have no where near as positive outcome.
Unfortunately, in a lot of cases, if you don't have a reference by another doctor, they'll fit you in whenever they feel like it. I was having some very serious back and leg pain, and had lost all feeling (except for my leg being on fire) in my foot, and began having to walk carefully, because I had a "foot drop." I tried to get in to see a neurosurgeon, and was told that he could see me in about 4 months. Even after I gave them the symptoms. I went to my primary care doctor, and she got me in to see the same neurosurgeon the following day, and an MRI that same day. I had a lamenectomy 2 days later. I had a disc that had extruded into my spinal canal. Waiting even another week would have probably landed me in a wheelchair for the rest of my life. 7 years later and I'm just now starting to get some feeling back in my foot, but I can wiggle my toes now!
Mark
Been there done that. Both my right knee and back hurt most of the time. I just put up with it. Ibupropen seems to help. Where is that bottle?
Vitamin B3 reverses Alzheimers in mice (and probably humans)
FReepmail me if you want on or off my health and science ping list.
You can thank the Drug Enforcement Administration, aka DEA, mostly for that.
Yup. That is what was going on with me. The internal did NOT refer me and I suffered for seven years. Finally I broke through and got in with another doctor. I hate the system we have now. BUT, adding layers as in socialized medicine will be much much worse.
Hammer, nail, head. Yes.
The docs I’ve talked with are so scared of having the DEA on their backs that they will not give me what I really need. The family has instructions to get as much oxycodone they can get and let me have what they don’t need.
Nope, I’m not addicted although in my efforts to get the meds I look like I am. I will horde it for when I need it because when I do need it I am in no shape to go around and get it.
Hey Jan, a thread for us!
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