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Knees and Flowers - cellophane
the story of an invisible girl
renniekins
renniekins
Knees and Flowers
Had my followup appointment with my knee doctor today. He had good news and bad news. The outside part of the joint? Very good. The middle part of the joint? Good. The ACL looks okay. The meniscus is not all that bad.

But the inside of my knee, on the femur, has a LOT of bare bone exposed. He showed me three or four photos of it. "Bare bone," he exclaimed. "That's bare bone, and that's bare bone!" (He gets a little excitable.)



"Well, just how much is 'a lot'?" I asked. He wouldn't elaborate. "Is it, for example, the size of a quarter?"

"Oh no, much more than a quarter."

"An acre?" I deliberately selected something unreasonable.

"Yes, an acre," he said unhelpfully. He showed me on a knee model sitting on the counter. "See how we've marked a few patches? If you combine all those patches, and then some."

I summarized. "So basically, all of it." All of it that comes in contact with the rest of the joint at any rate.

"Pretty much."

He took an x-ray of my knee, to make sure I didn't need a Steve Yzerman-like knee reconstructing osteotomy -- but my alignment wasn't bad enough to need it. whew! That basically involves breaking and realigning the bone, none of which sounds like fun.

So he said that the solution which (in his opinion) had the best chance of providing me with knee health is Carticel. I am a bit dubious of this though, because it's not used much (if at all) at U-M. I get the feeling it might kind of be his pet project. I've asked M to talk to doctors at U-M and see if other surgeons have different opinions or experiences.

He then said, if I were his sister, he would recommend the Carticel injections. When he went in there last week, he harvested some cartilage. All they have to do is grow it in a lab, and then stick it back in. Although they wouldn't just "stick it in" - they would in fact take a biological membrane, and stitch it to the good cartilage, making a little covered hole. Then he'd inject the cartilage into the pocket, where it would multiply, attach itself to the bone, and act like cartilage is supposed to act. Voila, new cushioning!

Then I asked him about recovery time, and he said it would involve two months on crutches. Two months! I asked about success rate, and he said around 80%. But then I looked at the online literature, and they say that needing an additional arthroscopic procedure is common, perhaps as much as 50% common! Ack.

So this is what he is advocating, but he said I should go home, read the literature, see how my knee feels when it's fully healed, and make my decision from there.

He said that the cells are good for five years, but by that time my knee will probably have deteriorated enough that I'll no longer be a candidate. He said I was likely to only be a candidate for a year, maybe two. It is his opinion that the cartilage will deteriorate further, to a state when it can't be repaired with Carticel.

I was fairly discouraged. Reading about it online, it looks like a LOOONG recovery period. Like as long as my first ACL took, maybe longer. Practically a year of my life. I don't really want to do that. But I'd like a nicely functioning knee.

He kept stating, "You're 37, not 47. We need to buy you more time." A statement which left me with the uncomfortable impression that when I am 47 or 50 he sees himself giving me a new knee. Or maybe just a partial knee replacement. Either way, another big nasty surgery.

I'm not sure if he's just too gung-ho about cutting up my knee, or if this is reasonable given what he found inside? M's ideas of surgery and recovery seemed much more conservative when we spoke earlier -- like he thought the surgery I just had should last 15 years or something. I've asked M to talk to some of the docs he works with, and get their opinions on Carticel and stuff.

Anyway I'm discouraged right now, but really no decisions need to be made until a few months from now. Once it fully heals from the scope, and once I start using it for day-to-day activities. Once I try some skating and other more aggressive sports, then I'll know if I've achieved any pain reduction, and if so if it's enough.

For now it's all speculation, and thus not particularly helpful.


On the plus side, I got my stitches out -- YAY! Plus, when I got home I found a big box of flowers sitting on my porch!! They were sent from my ex-employer, "Wishing you a speedy recovery, -The Xede Family" How wonderful and kind, especially given my resignation! It made me feel guilty and warm and fuzzy at the same time. They smell lovely. I sent them a very nice thank-you email.

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Comments
kyril From: kyril Date: May 20th, 2009 05:50 am (UTC) (Link)
I's sowwy you have kneesles. :(
jenx From: jenx Date: May 20th, 2009 12:47 pm (UTC) (Link)

My .02

After reading all this, I would go with the Carticel. The recovery time sucks, but it would suck just as much as a full knee replacement. Another small surgery after Carticel is a coin toss - but having my own cartilage sounds preferable to having a titanium knee. And it's possible that another knee replacement would have to be done later in life - what's the life span on those?
devnul From: devnul Date: May 20th, 2009 03:20 pm (UTC) (Link)
Two thoughts:

Stop any deterioration now. It will have adverse effects on both your knee and also your other leg joints as your body does any compensation. Putting it off just means it will be worse later.

A friend of ours just had a replacement knee done in late Februrary. He's hiking again already. If it comes to pass that you need one in a decade or so, while there's very definitely a recovery period and some unpleasant PT, it's not long.

(no subject) - davehogg - Expand
renniekins From: renniekins Date: June 9th, 2009 04:07 am (UTC) (Link)
Old people with knee replacements, or young(er, like me) ones? Are they still athletic?
renniekins From: renniekins Date: June 10th, 2009 04:53 am (UTC) (Link)
ah-ha, maybe that's what I need to bump up my earnings then!
jeffreyab From: jeffreyab Date: May 20th, 2009 06:53 pm (UTC) (Link)
Nice that your former employer sent you flowers.

Good luck with the knee.
mbumby From: mbumby Date: May 20th, 2009 07:07 pm (UTC) (Link)
Lovely flowers. Especially nice that they're from the _ex_ employer. Can't give you advice about how to jump on the various treatments -- if I try to read the medical information my eyes and brain will fuzz, and besides, you need to figure out how _you_ feel. However, I agree with the person who said "stop any deterioration now", and the notion of actually having clones/children/whatever of your own cartilage sounds ... better ... than alternatives.

Forgive me if you've said, and I missed it, or don't remember, but do they know WHY your knee/s are so ornery? Is it just injuries (i.e. they've been around the block as much as the average 57 year old) or is there some way your diet can change that will make it less likely to be a problem in 'n' years' time?
renniekins From: renniekins Date: June 9th, 2009 04:05 am (UTC) (Link)
I think the problem I'm facing now is that I had a bad injury (15 or so years ago), I had multiple surgeries with older techniques, then I used it aggressively for 15 years. It worked well for a long time, but now it's falling apart.

The original torn ligament, and the more recent (2004) torn ligament in the other knee -- might just be bad luck, or it might be a genetic tendancy.... hard to say.
mbumby From: mbumby Date: June 9th, 2009 01:20 pm (UTC) (Link)
I know the medical community is .... divided at best ... but one does wonder, though, if supplements (glucosamine is the one that comes to mind that I've heard of) might make your jointy body parts happier. Unfortunately, that's not something you can *see* after a short period of time is causing improvements.

I don't like doing drugs myself, but I'm firmly in the better (continued) living through chemistry camp for ... I guess it's now 3 or 4 reasons and counting.

multiple surgeries with older techniques sounds like the right thing to have done at the time, though. Even if technology/technique got better in the meantime, you probably didn't need the treatment "a decade later".
pi3832 From: pi3832 Date: May 21st, 2009 11:04 am (UTC) (Link)
Why is this news? I mean, he should have seen that your cartilage is gone on your pre-op x-rays. Or on an MRI.

Once your knee is healed from surgery, I'd say get a second opinion, based on a new set of x-rays and MRI. Yeah, that's a PITA, but less of one than more surgery!

And you'll need to start bicycling more, since you should stop climbing stairs and running.
renniekins From: renniekins Date: June 9th, 2009 04:01 am (UTC) (Link)
The xrays shows arthritis and cartilage deterioration, and the MRI indicated that significant state 4 arthritis had occurred with exposed bone. But without going in, he didn't know *how much* exposed bone, and what kind of treatments were there.

He found a good news/ bad news scenario. Of the three parts of the knee, two were good. Of that remaining third, one half was good and one half was much worse than we'd been hoping. So the good thing is that most of my knee is doing quite well. The bad part is that there is a large chunk of completely exposed bone, which is not good (a small chunk would have had chance of microfracture repair, but this is too large).

I'm seeking other options, or rather I'm having M talk to his docs about what they'd do. their opinions all differ. The problem is that cartiladge repair/regeneration is such a new field. *sigh*
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