OK! now, how do you get the surgeon to do the job?

[knee]

So, I read up on everything surgical. Have no cartilage in either knee...plus minescus(sp) tears...MRI's done for proof...and this surgeon whom everyone in San Francisco thinks is super with the surgical skills...backs down and says "there are steps to follow...we try to delay knee replacements as long as we can"...I'm ready. I do not have 10 in knee pain, nor do I want to wait until I do. I'm 67, lost ten pounds, swim and work the ex. machines like some maniac..and he says..".oh, well and hem hah"..I figure, get both MRI's in MY hands, then ask him point blank "when IS the right time" then start looking for second opinion...what have you encountered? I will NOT wait until I am hobbling about...doesn't make any sense!

 

[Nursepair]

You're right, it makes no sense at all. I would definately get a second opinion. Most of us here are younger than you and have had our knees done, and no one has regretted it (yet anyway). There is no reason to delay. The prosthesis nowadays last a lot longer than older ones, probably 20-25 years I think.

Good luck, and find someone who does a lot of knees. Sue

 

[referee54]

My docs said that they were obligated to try to take the least intense route first---I went through the SynVisc, the cortizone (normally that protocol is backwards) and then the Bilateral TKR's. Insurance companies also may have some say---they want to do the least invasive first...I was 53 when I had mine done, but I had exhausted all other routes before that.

I believe that most MD's will not do major surgery (Which this obviusly is) unless they absolutely have to. If you haven't tried SynVisc (or the others) I believe that you owe it to yourself to go through that regimen of treatment first.

Tim C.

 

[AlaskanTKR]

The question that finally came into our discussions was - is it impacting general quality of life. When I answered yes we knew it was time. I Had mine scoped 4 times and ended up with no cartilage and no meniscus on the lateral right knee. Then I had several mini traumas to it this winter and totally lost everything with the knee. The difference in xrays over the past 2 years was unbelieveable. I thought I would be dealing with synvisc this summer or at most a partial - but - he said tkr was the only real alternative to restore quality of life. I had a great year following the last scope so I know it is in me. We are hoping that this gets me back there and keeps me there for at least 15-20 years!
(I am 42 and my progressive OA is the result of trauma to the right knee)
Marianne

 

[Josephine]

There is an inherent and deeply ingrained philosophy in medicine "Little guns first". Few surgeons these days are 'knife happy' as they know to their cost that people who (appear to) rush into surgery are often the ones who have the most regrets.

Now I am not saying this applies to you, just explaining where the surgeon is coming from.

Never the less, what Marianne has said is good, wise counsel. Make an assessment of every facet of your ADLs (activities of daily living) - this Wikipaedia contains a pretty comprehensive list - grade each one on a scale of 1-10 and then take it to the surgeon for discussion. That should get you a bit further as he will see that you have given this considerable thought. If he still doesn't comply, then find yourself another surgeon!

 

[JudyS]

I agree with Marianne and Jo. I have had a thoracic spine issue getting progressivly worse over the last almost 2 years. I have had this same doc the whole time. He always tries all the conservative measures first.
Last spring, surprisingly to me my neck started bothering me. I brought him an x-ray that had been taken at the chiropractors. Well, he took one look and said, you will need surgery for this. First I went to pt . With no change in symptoms , actually a rapid increase in symptoms we decided on surgery .

With the thoracic, however, I have had pt and injections. Not much difference. Now it has stepped up its annoyance and he is sending me to pt once again and will try more injections before any surgery is considered
although I can be miserable with this, I dont want to rush into anything. As I am recovering from the hip, it is difficult for me to tell how much it affects quality of life right now.

Sorry that was soooo long.
I would be suspicioius of any doc that saw you once and said surgery(unless you were in the er)

Judy

 

[knee]

You're right, it makes no sense at all. I would definately get a second opinion. Most of us here are younger than you and have had our knees done, and no one has regretted it (yet anyway). There is no reason to delay. The prosthesis nowadays last a lot longer than older ones, probably 20-25 years I think.

Good luck, and find someone who does a lot of knees. Sue

I think I like you! I get to thinking sometimes, that I'm the one not thinking reasonably...doubting myself..doesn't help the anxiety...I plan to confront him when I have both MRI's in front of him, and simply ask, based on the pictures, when does he think ...and I apparently haven't made enough of a case about how this lack of walking freely IS impacting my life. We'll see, MRI this Sat. Next Dr. apt. Aug 12th..

 

[Lbee]

My doc is in Concord, CA and is a great sports medicine doc. He specializes in knee replacements and does them 2-3 times a week. He took x-rays which disclosed that I really had no other option but to have the joint replaced. Look for a doctor that does knees on a regular basis. My doc used a computer for the replacement and alignment. Your doc may be hesitant because it will involve a lifestyle change for you for awhile, you seem very active.

 

[Simon]

The insurance company does at times have some pull as they don't like to spend the money but it is up to the doctor to say, doing x, y, z will not help and that the only option is knee replacement. I was lucky the insurance company did not make me doing anything before approving the surgery. Then with a past history of multiple sugeries, x-rays that showed all cartilage was gone and there was bone edema it was pretty obvious what was next.

All the suggestions that were given are good ones.

Good luck

Simon

 

[knee]

My doc is in Concord, CA and is a great sports medicine doc. He specializes in knee replacements and does them 2-3 times a week. He took x-rays which disclosed that I really had no other option but to have the joint replaced. Look for a doctor that does knees on a regular basis. My doc used a computer for the replacement and alignment. Your doc may be hesitant because it will involve a lifestyle change for you for awhile, you seem very active.[/QUOTE Who IS your Dr. in Concord?] He has the attitude I want. My lifestyle is already compromised. Walking just three blocks is a unpleasant experience. I so miss just walking whenever I wanted, with no thought involved, now, I have to plan the days...it's pretty sad..I had a good cry today. Don't like taking vicodin just to get outside! Losing my laughter, bigtime!

 

[knee]

The insurance company does at times have some pull as they don't like to spend the money but it is up to the doctor to say, doing x, y, z will not help and that the only option is knee replacement. I was lucky the insurance company did not make me doing anything before approving the surgery. Then with a past history of multiple sugeries, x-rays that showed all cartilage was gone and there was bone edema it was pretty obvious what was next.

All the suggestions that were given are good ones.

Good luck

Simon

I'm hoping both MRI's when viewed without any excuses will help the decision. He wants to do an orthoscopsy...with only a 60% recovery rate...then 2-4 months rehab...for what? Just to turn around and do it again? I just don't get it. And I'm certainly not excited about all the grind ahead with surgery, rehab, etc. but I so want to just walk at ease again. Now, even the shortest walks are just plain unpleasant...that is so sad for me. I'm not old, I just have these joints...I am feeling old..don't like seeing myself that way. I'm 67, not 78. Thanks you for your sincere reply!

 

[JenniferG]

My experience has been similar to what Simon was saying. Insurance wont show up/pay up until you have tried (Jo's) little guns first. Have you had the synvisc shots? Are you on the vicodin for your knees? From the same doc who wants to hold off on your knees? When he said there were steps to follow, did he explain what they were so you could start following them? My steps were nsaids, synvisc, and PT. When none of those helped, surgery became the final step.

 

[Josephine]

Arthroscopy is usually carried out as a diagnostic tool rather than treatment. While there, the surgeon may tidy up torn and frayed tissues and give the joint a good washout which may help in the short term but it's main purpose is to confirm the diagnosis.

 

[Lbee]

The doctor's name is John Merson at East Bay Sports Medicine in Walnut Creek and Concord. Research him and see what you think..