Synvisc shots: should I be nervous about getting them?

[newlybionic]

I have had different kinds of injections in both knees over the last 10 years or so. For me some of them were very painful and I had no relief. My current OS has given me cortisone shots that were not painful and he told me that if the others caused me pain it was because the other OS was not good at giving them. So if your OS is highly recommended then I wouldn't think twice about getting them at all.

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[Carole4815]

So if your OS is highly recommended then I wouldn't think twice about getting them at all.

He is, and from what you and others are saying on this thread I feel a lot more confident now. Thanks. After I have had my Synvisc shots on Thursday, I'll post and let everyone know how it went.

 

[Josephine]

I've had cortisone shots in me shoulders every 6-12 months for about 10 years and it was no different to getting a flu shot! Mind you, it rather depends on who is on the other end of syringe!

 

[Carole4815]

Thanks, Josephine! I am so encouraged. I have no trouble at all with flu shots or other normal shots, so from what you and others here are saying, it sounds like I have little or nothing to fear. Whew!

 

[Lovestoread]

In the years leading up to my TKR's I had two series of shots (3 each, one week apart) in one knee and three series in the other. My doctor didn't numb them at all and I was just fine. They feel like, well, you're getting a shot. Just the thought of having shots in my knees gave me the willies, but turned out to not be a big deal. Both of my knees were bone on bone, but surprisingly, I had quite a bit of relief from them. Many here do not get much out of them. The first series I had lasted about a year. My knees weren't perfect, but I was relatively pain-free. The next series gave me about 6 months pain-free. The last set lasted about a week. That's how I knew it was time for TKR. With each of my shots, the doctor just put a band-aid on and sent me on my way. I was able to drive home just fine. I thought my knees felt a bit stiff for the rest of the day, but I found that putting an ice pack on helped a lot. Good luck!

 

[Carole4815]

Thanks, Lovestoread! That's a very good report and I'm so glad the shots worked that well in your case. Yesterday I received two brand new, big, knee-sized ice packs that I ordered from Amazon. I'll put them on my knees after I get home after my shots on Thursday - - good idea.

 

[Bikesouth]

Synvisc one helped me delay TKA for a few years until I became bone on bone. Then it lasted about two months.
My Ortho puts a little cotisone in first, then Synvisc.

 

[Jamie]

That was an interesting quote about Medicare. Did you copy that from the Medicare site? A link to the source would be helpful. I had both my knees done under Medicare and I didn't have to go through all that first. I had Supartz injections with the first knee (didn't hurt but also didn't work) and went straight to the TKR with the second knee. If it's a Medicare rule to have to meet all those prerequisites, somehow my surgeon got around it all.

I just had a thought, though. Are you covered by a Medicare Advantage plan? They operate differently sometimes than regular Medicare.

 

[Carole4815]

Bikesouth, that's interesting that your OS puts a little cortisone in first. Also, encouraging that Synvisc worked so well for you for a couple of years.

Jamie, I got it from an orthopedic clinic's website, broken link removed: https://www.basinorthopedics.com/Medicare-Changes.html. A Medicare link substantiating it is broken link removed: https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/se1236.pdf and that probably is what I should have quoted and linked to in the first place. My apologies.

I wouldn't be at all surprised if surgeons have figured out a way around it, though. I'm so glad you did not have to go through all that first! Maybe I won't, either. I'd love to just be done with this and go on and get my TKRs done ASAP. The sooner they are done, the sooner I will be able to start on the recovery phase, and eventually walk places and do things again.

I'm not on Medicare Advantage; I have Medicare as primary, and BCBS retiree insurance as secondary.

 

[Carole4815]

I am so upset. I went to the OS for my appointment today, with my boyfriend in tow so he could drive me home if necessary, and as for me I was half ready to pass out from fear. We waited for two hours past my appointment time, his staff didn't even weigh me (when I am supposed to be losing 25 pounds), and when I got in to see him the OS said that there was a misunderstanding. They hadn't ordered the Synvisc shots or had them approved by my insurance. I don't see how there could be a misunderstanding because otherwise, why did I even have an appointment? He wouldn't listen to me and acted like he didn't even know who I was, asking me things like what else I had had done for my knees in the past, but not giving me time to even answer his questions.

I know I need to calm down before making any decisions, because I am exhausted and furious beyond belief right now - - but I'm thinking of either switching to another OS, or just ditching the whole effort and giving up on ever getting anything done about my knees. I have lived with knee pain for 20 years already, and my life expectancy is less than that. Honestly I thought I found a doctor that cared, wanted to help, and had a plan of action. Silly me.

 

[gertie]

Wow! Sounds like they really messed up. I would think that making your appointment for the shots should have triggered their ordering them and starting the insurance approval process (which took a month in my case). I'm not surprised you're angry and tired. But I do encourage you not to give up on taking care of the knee pain--possibly with a new OS.

 

[Celle]

I'm sorry you had such a bad experience. When you feel a bit better, I think it would be a good idea to phone and ask for an explanation. Did nobody say anything to explain why they kept you waiting for 2 hours?
Since your surgeon didn't seem to realise he had seen you before, I wonder if he was given the wrong notes?

What happened to you isn't acceptable. I would certainly express my concern and tell them (preferably in writing) how upset you are and how it caused you to lose confidence in the surgeon's set-up.

 

[birdwatchr]

Aw.... don't give up totally.... coming from someone who did! The first ortho I went to laughed in my face and asked what was I whining about? It wasn't THAT bad! I went to his stupid pt.... first words out of their mouth was "can't do much for your knee". Pcp suggested someone else, when he realized what had happened, so after a few months, I went to new dr. He was wonderful, although he did not do tkrs. He told me no wonder I hurt.... it was bone on bone. He treated me for a couple of years, while telling me I needed to consider tkr. He finally referred me to tkr dr. So.... I would go ahead and find someone else. However.... if you decide to give this Dr another chance, I would only give him one, just in case he was having a bad day. But I think maybe you are too uncomfortable with him right now. What does your boyfriend think? You could decide together what to do. But don't give up on getting treatment. My knee finally collapsed, and maybe I shouldn't have gone so long resisting surgery. (But I'm doing fine now!) Just don't want you to give up entirely!

 

[newlybionic]

Please don't give up on finding a way to have pain free knees. For me if that had happened I would be seeking another OS. I went ahead with an OS for my original TKR that I didn't feel 100 % confident of and I paid for it when I found out he had made a mess of my knee and I needed a revision which I had 8 months later. If you feel like something is hitting you the wrong way with that OS and his office then he is not the one for you.

I missed some of your earlier posts until now but the info you cited for Medicare is for those on Medicaid which have a much more strict progression of steps that have to be taken while working up a diagnosis for most medical problems. With original Medicare you don't usually have to jump through the same hoops. I have watched my friend have to deal with that system and it just causes more problems because the doctors can't decide what should be done for their patients.

 

[Carole4815]

info you cited for Medicare is for those on Medicaid

Hmm. I guess I don't understand, then. The broken link removed: https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/se1236.pdf on the Medicare website said,

"The Centers for Medicare & Medicaid Services (CMS) is publishing this article as an educational guide to improve compliance with documentation requirements for major joint replacement surgery. The article presents suggestions for documenting medical necessity to avoid denial of Medicare Fee-For-Service (FFS) claims." (emphasis mine)

That is what led me to believe it applies to Medicare. I imagine there could be various ways to avoid denial of claims, as these are just suggestions for acceptable ways to document medical necessity; I'm thinking that different doctors probably approach these documentation issues in different ways. Also, I'm not sure but it looks to me like this might be a new rule change adopted just last August 24th? I'm a little confused about when it took effect or will take effect.

Either way it won't matter much to me if I just give up on my knees. I probably won't. Right now I'm tired, stressed out, feeling a little sick, depressed, furious, achy, exhausted, and miserable. A good cry and a good night's sleep will make a world of difference.

 

[mamazipp]

Please do not give up on your knees. You don't need to live with knee pain from osteoarthritis. Perhaps give up on your OS. Ask people for names, ask your primary care doc. There are other OS people who will treat you respectfully and will replace your knees.

 

[Carole4815]

Mamazipp, and others, thanks. There's another orthopedic surgeon who (according to statistics I found somewhere on this site?) does 150 knee replacements per year, which is several times as many as this OS does. When I am feeling less upset I'll do some research on his other qualifications and maybe think of "jumping ship".

There's a slight possibility that with me being as nervous as I was about Synvisc, maybe I just came unglued when the procedure had to be delayed and maybe I vastly overreacted. I am usually a very rational person. But right now I do not feel one bit rational, and not only that, my stupid knees hurt like blazes! LOL Oh!!! I need to ice them. See? This discussion is helping because I was so mad I didn't think about that.

 

[Celle]

with me being as nervous as I was about Synvisc, maybe I just came unglued when the procedure had to be delayed and maybe I vastly overreacted.

Don't go blaming yourself in any way for this. Any doctor who keeps you waiting for two hours for a booked appointment owes you an explanation.

I second the advice to look for another surgeon - one who does more than 150 knee replacements a year, if possible. You don't want someone who just does it as a "hobby" or a sideline to his/her general orthopaedic surgery. You need someone who specialises in knee replacements.

 

[Bikesouth]

Sorry you had this experience.....my gut says go elsewhere.

FYI my Doc writes the Synvisc script & has the patient purchase the injection. Then you bring it in at your appointment. They told me they see way too many patients and could not manage it between working in two locations and surgery on Mondays.

 

[Dancing Fool]

I agree with the "go elsewhere" folks - especially since your current OS doesn't do very many TKRs. You were treated very poorly - I wonder what they thought the appointment was for?!

With a new OS, perhaps you can discuss going straight to the TKRs without bothering with the Synvisc, especially since it is so frightening for you. I'm on Medicare as primary for my upcoming TKR, too, and after reading your original post I was concerned because I clearly don't meet that criteria - I haven't had any PT for this knee, and I certainly haven't tried external bracing! I found the same websites you did. I talked to my OS's office yesterday and they said they don't bother with prior authorization for Medicare, and haven't had any trouble getting payment. Since my TKR last year was before I was on Medicare, I was afraid they had missed something.

I did have several series of Synvisc shots in both knees and they "maybe" helped a little, but that was probably 4-5 years ago before my knees got so bad. Even if they worked for you, if your knees are bone on bone, it's only going to delay the inevitable. Good luck with finding a good OS that will treat you well!