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Synvisc shots: should I be nervous about getting them?

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It is certainly time to look elsewhere---on many accounts. The first one, of course, is the way in which you have been treated---which is horribly unprofessional and equally impersonal.

Secondly, you need to find an OS who does nothing but TKR's and THR's---one who specializes in them. I truly believe that you do not want an OS who merely "dabbles" in them---nor do you want an OS who does not care about you, your health, or your concerns!

When I was going through the protocol approaching a TKR (actually a BTKR, I asked my OS when he would do them. He replied that he did not perform a TKR or a BTKR. I then asked him, if he needed a TKR, whom would he select---I figured that an OS---or any MD for that matter, would know who he wanted cutting him. I met with the gentleman which was recommended, and he performed my BTKR. If you look at his resume, that is all he does---TKR's and THR's. He knows his stuff.

You need to lose the OS that you are seeing now and find one who will truly take care of you and meet your needs as a patient.
 
I would think that if you are bone on bone they don't have to implement the other protocols. I did them only because I had some fantasy that doing shots, PT, etc, would make me better. I just couldn't accept that I needed a TKR. Once I did, tho, I went on overdrive to do it.
Find a good OS and don't worry about Medicare protocols. The docs know how to submit medical notes for approval and they enjoy doing the TKRs anyway.....
 
Definitely look for someone with lots of experince with TKRs. Now I wonder if they even ordered your shots. I always receive a phone call from a pharmacy, Walgreens usually, asking if I ordered the shots and if I was willing to pay for them. Then a few weeks later I get a phone call from the OS office to schedule appointments. All of this takes over a month, but in the meanwhile you can ask for a cortisone shot to help with pain until the shots come in.
 
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I totally agree with everyone else that you should find another OS. I also wanted to tell you that I am on Medicare and the only things I did before I had the surgery were cortisone shots, which didn't help, and about three weeks of PT which I stopped at my therapist suggestion because it was doing no good and actually making me hurt worse. I didn't have the other shots because my OS didn't think they would help.
 
Thanks, everyone. I'd respond to you each individually, but right now I'm having a huge pity party here by myself. :heehee: Oh well. I probably need to just chill. Not sure what I'm going to do or not do other than that, but I sure appreciate all the sympathy and suggestions from each and every one of you.

The only thing I know for sure is that having crummy knees is no fun, that pain is no fun either, and that all of you know exactly what I mean. I hope all of us who are still in pain end up with better knees soon.
 
If the new surgeon you're considering does an average of 150 TKRs per year and your current doctor does significantly fewer of them, then you definitely need to change! 150 is the lower end of what we recommend for a surgeon to be considered "experienced." Look on what you just experienced as a very fortunate event that will allow you to get to someone who specializes in TKRs. Selection of the surgeon is the number one most important factor in a successful outcome. Go ahead with your pity party if you need to this weekend, but come Monday put on your Big Girl Panties and get on the phone and internet. You've got the rest of your life to enjoy and you need the right person to help you get there!!

The document you linked was published quite some time ago, but it was updated in 2015 for things other than we have been discussing. I noticed in my quick look that there appeared to be "suggestions" for treatments to avoid denial, but also there was a "catch all" caveat at the end that would allow a doctor to write a treatment opinion that should permit going directly to the TKR when medically necessary. The fact that your current surgeon didn't know how to deal with this and was going to make you go through a series of treatments further supports my thoughts that he's not experienced enough in this type of surgery. Another "truth-teller" is the fact that he had to "order" the injection. My surgeon had the Supartz in the office and ready to go the day we decided to give them a try.

Thanks for the link, though. I intend to go over it in more detail later in the weekend.
 
I just took a look at the website you provided and am going to assume that your surgeon is one of the two doctors I see listed with the clinic. The practice focuses on "sports medicine" which is usually not the type of practice we recommend for TKR patients. Many times doctors in a sports medicine practice do fewer joint replacements and instead focus on problems resulting from sports injuries. If you'd like to tell me the doctor(s) you're considering changing to, I'd be happy to take a look at their websites too.

I am a bit confused, though.....your profile says you're in New Orleans, but the clinic you referenced is in Odessa, Texas.
 
Jamie said:
I just took a look at the website you provided and am going to assume that your surgeon is one of the two doctors I see listed with the clinic. The practice focuses on "sports medicine" which is usually not the type of practice we recommend for TKR patients. Many times doctors in a sports medicine practice do fewer joint replacements and instead focus on problems resulting from sports injuries. If you'd like to tell me the doctor(s) you're considering changing to, I'd be happy to take a look at their websites too.

I am a bit confused, though.....your profile says you're in New Orleans, but the clinic you referenced is in Odessa, Texas.
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Jamie, the link I gave you was not from my clinic, but just something from the internet that I thought was exceptionally clearly written and interesting. I thought I said that (edited to add: see post #29), but apparently I wasn't clear myself! I didn't think anybody but me would be all that interested. Anyway, since some people were, I searched for, found, and provided the link to that article by Medicare, about Medicare, just for those who wanted to read something like that. :)

The Medicare article was not as clearly written (IMO) as the first article, but while probably less useful in that respect, still it substantiated that as of last August 23rd they were providing these same "suggestions" as a guideline to surgeons who want to be sure that their claims aren't denied.

Sorry I was so unclear about everything. The clinic is not my clinic at all but what a well written and clear presentation, I thought. Whoever wrote it has a lot more writing talent than I could ever dream of. I only brought it up because I thought it was interesting since I wonder if possibly some/many surgeons might tend to follow these procedures now that they have been "suggested", whereas I suppose others might not. Actually I know I said that before so I hate to just go on and on and on saying the same things.

It seems that instead of inspiring a reaction of "Oh, how interesting, hmm, wonder how this may or may not influence pre-surgical procedures that began after August 23rd", apparently I have unintentionally inspired some defensive feelings from people about their surgeon's past pre-surgical procedures (which likely first began long, long before the Medicare suggestions were provided, I believe on August 23rd, 2016?). There is no need for anyone to feel that way at all because their claims went through. I am sorry if I gave that impression as my intent was not to threaten anyone or "diss" their surgeons' procedures, but merely to point out that Medicare does have documentation requirements if they are going to pay, and has provided "suggestions" to help surgeons meet their requirements in the future.

Would you feel better if I deleted the links and my quote from that one article? I would be glad to do so if that would help in any way. I am beginning to feel like the information, even the information straight from Medicare (not Medicaid!) is making me very unwelcome here.
 
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Carole, of course you're welcome here. We're here to help you as much as we can.

People have different experiences and their surgeons often have different policies. We accept all their experiences.

Please don't be upset. Jamie was just trying to clarify things.
 
Thanks, Celle. I came back because I wanted to tell Jamie (and you) that if I seem unreasonable it's not you! My knees are causing me pain and when that happens, even when I try to ignore it, I seem get less reasonable and harder to deal with. That is probably true for many of us, which must make it awfully hard on Jamie and other staff members. It's not intentional at all. :sad: Honestly I can't even imagine the challenges involved in overseeing a forum full of members in pain.
 
The good thing about BoneSmart, Carole, is that we understand how you feel. We've all had joint replacements and we've all had that awful, unrelenting pre-op pain.
We've all worried about what the surgery will be like and how we'll cope with the recovery.

We understand if you want to vent, and we'll listen, because most of us have done that , too.

Hugs to you. We'll help you through this. :friends:
 
Celle said:
The good thing about BoneSmart, Carole, is that we understand how you feel. We've all had joint replacements and we've all had that awful, unrelenting pre-op pain.
We've all worried about what the surgery will be like and how we'll cope with the recovery.

We understand if you want to vent, and we'll listen, because most of us have done that , too.

Hugs to you. We'll help you through this. :friends:
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Celle!! :friends::friends::friends::friends::friends::friends: You and Jamie and all the Bonesmart staff are so nice and so kind. Thank you for understanding.
 
Oh no, @Carole4815 ! Everyone is feeling badly FOR you, not at you. We tend to go to battle for our friends here and I believe everyone was aghast at how you were treated. Jamie will let you know what to do with the article, I haven't read it as I'm not on Medicare yet and since I've just retired I'm feeling old enough. :old:

You explained your clinic very clearly above. I concur with Jamie, that you want to find an OS who does a lot of TKRs, 200 is a good number to look for when speaking with Offices. When my dad needed an emergency THR a year ago the first thing I asked was how many THRs he had done.
 
I just wanted to say that my original Ortho doc had the Synvisc in his office. I had the kind where you have three injections, one week apart. I asked him about the one-injection version of Synvisc. I was told that he didn't stock it, but if I wanted that, he would write a prescription for it and I could pick it up and bring it in with me. I don't think it's that uncommon to have you get it yourself and bring it in.


Sent from my iPad using BoneSmart[emoji768]
 
Carole......I'm so sorry if anything I wrote came across as negative to you. It was not intended that way at all!!! I really appreciate it when any member provides us with links they feel are useful here on the forum and I was glad you came right back with that Medicare link. You're right though...turns out I did misunderstand the clinic link and thought it was YOUR surgeon's website. Now I understand .... please forgive my confusion.

I do want to read through that Medicare link more carefully though. One thing we really try to do here on BoneSmart is to help clarify guidelines like this when needed to make sure our members are armed with solid information about their insurance coverage when they talk with their surgeons. Our lovely government (I can say that because I am a retired Federal employee) can sometimes really put out less than perfect guidelines. This Medicare document is one of those! I cannot believe they didn't just date the thing according to when it was last updated, but nooooo......they left the original month and date it was written (August 24th) but put the year it was last updated (August 19, 2015) in a yellow highlighted paragraph below that original date. I was confused about when it was written and almost missed that update paragraph. I bet that happens to others too! That means most of the document is several years old (written no later than August 2013), as Kathleen Sebelius has not been the head of Health and Human Services since she resigned in April, 2014. So the bulk of the article is at least that old. That doesn't mean it's not accurate.....it probably is the current Medicare policy. During my brief glance at it, I noticed some typical government "weasel wording" though that could allow a doctor to avoid putting a patient through injections, therapy and the like before getting a TKR. That's what I want to go back and highlight for everyone.

The clinic website you linked is interesting too because they seem to have interpreted the Medicare guidance as YOU WILL do all these things before a TKR for Medicare patients. I have to wonder about a practice that does that and think maybe they have chosen that policy to increase their own bottom line when billing Medicare!

As I said, I'm VERY thankful you located this document so we can discuss it here on BoneSmart. I think it will be helpful for many out there and I plan to put something in our Library for reference. You have helped me immensely by finding this information.
 
Jamie, I am glad if you enjoyed the article and I guess the next step is deciding for yourself whether or not it is useful to you. If not, that's fine, just drop it, no problem. If so, you're welcome. I hope you don't think badly of me for this, but I'm too exhausted and hurting too much to continue this line of discussion.

There are a plethora of articles by and/or about Medicare available to us via Google. These were both on the first page of my first very cursory Google search of the topic. I am sure you will find many more, some better or more applicable, if you should choose to research the topic further. Have a nice evening. :)
 
I agree completely, Carole! Let's keep the focus on getting you through this rough patch. We're here for any questions or just for a rant if you need to unload a bit. It's difficult to be patient when you're in pain. I'm sending you a virtual hug to help you through today! :friends:
 
There are many aspects of this that are both painful physically and psychologically. I understand how much you hurt and how frustrated you are. I was in pain pretty much 24/7 and the intense pain in both knees would wake me up with a jolt at night when I would roll over in bed.

Compound that with the ever-so-slow mechanics and protocol for setting up the TKR---and to have your OS treat you like that---it has to be horribly frustrating.

Please remember that we will be with you throughout this entire "ordeal"---and we look forward to reading about your success stories after you are recovered!
 
I am in the midst of a series of 5 Hyalgan shots. When my Dr. gives them to me she gives me Lidocaine shots to numb the knee. As soon as I am good and numb, she draws off any fluid that I have in there (I am bone on bone) so I get fluid from the arthritis and the swelling. Then I get a steroid shot or cortisone, and then she gives me the gel shot. I don't feel anything but a bit of pressure because the gel itself is quite thick. Then I am home to ice, take Ibuprofen & Extra Strength Tylenol, and take it easy for 48 hours after. I have some minor bruising and a little swelling and that goes down by the next Friday when I am back at it.
 
Dena62 said:
I am in the midst of a series of 5 Hyalgan shots. When my Dr. gives them to me she gives me Lidocaine shots to numb the knee. As soon as I am good and numb, she draws off any fluid that I have in there (I am bone on bone) so I get fluid from the arthritis and the swelling. Then I get a steroid shot or cortisone, and then she gives me the gel shot. I don't feel anything but a bit of pressure because the gel itself is quite thick. Then I am home to ice, take Ibuprofen & Extra Strength Tylenol, and take it easy for 48 hours after. I have some minor bruising and a little swelling and that goes down by the next Friday when I am back at it.
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Thanks, Dena62. That's encouraging. I still haven't had mine but after reading your posts, and the others on this thread, I have a much more positive attitude about them.
 
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