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Author Topic: Should I search out another OS??  (Read 4048 times)

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Offline Mandy

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Should I search out another OS??
« on: June 28, 2006, 04:58:22 PM »
Hi everyone~

I had my OS appt yesterday afternoon.  Spending 4 hours in an Orthopedic clinic really isn't one of my favorite things to do!!  Instead of posting how my appt. went again, please go ahead to http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=27742.0

From the way my OS was acting yesterday and his words, I felt that he wants to give up on me but yet doesn't want to admit it.  I know typing out what he said doesn't help in understanding his tone and demeanor, but does anyone here feel that he's ran out of ideas and just putting me back on the cycle I've been through before??  The first thing I tried while I was still with my previous OS was the stretching and anti-inflamms.  My current OS had me do that after my second TTT as well.  It's almost like his cushion.  While I realize that stretching remains a good thing reguardless of knee pain, I just don't see how the grinding and stabbing medial joint line pain I get has to do with it.

I guess long story short, should I maybe seek out another opinion about things?  It almost feels that since my current OS has been dealing with all of my maltracking issues etc. he can't seem to get out of that mode.  Even though my tracking is right, my OS really only mentions that I'm tracking ok and just assumes that my pain should dissappear.

There is an OS at the U of M, that is also mentioned on the KneeGuru board.  He's a knee specialist and also works with ice hockey players.  Do you think he's worth giving a shot??  http://www.umphysicians.umn.edu/physicians_detail_objectname_LaPrade_Robert_4254.html

Lastly, any suggestions on how I can really convince my parents to schedule an appt. with this guy?  While I am the deciding factor in my treatment, everything goes through on my parent's insurance.  I mentioned that I found a potential OS to my parents and they didn't like jump around going "Of course!!", but they were kind of like "well, we can see, maybe it is time for fresh eyes".

Any help would be great.  Thank you all so much for putting up with ALOT of venting coming from me.

~Mandy :)
21 yrs old
12/04: plica removal (RK)
2/05: debridement, LR/TTT (RK)
6/05: debridement, LR/TTT (LK)
10/05: scar tissue removal/debridement (LK)
3/06: screw removal (both knees), debridement on TTT site (LK)
5/08: debridement, HTO, Maquet procedure (LK)

Offline kera4

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Re: Should I search out another OS??
« Reply #1 on: June 28, 2006, 05:43:36 PM »
Dear Mandy, I have been struggling with the same sort of situation with my old OS. Even though our surgeries have been different, I feel I too need a different approach. I had 2 lateral releases in 1999, and scar tissue clean ups in 2003 (4 surgeries). The OS who did my scar tissue clean ups did a good job, but I now suffer with medial (instead of lateral) patellar pain, and a lot of tendinitis. I have don TONS of PT, and have not made much progress. I did see another OS who is a Patellar Femoral Specialist, who did give me a different perspective. His research indicates that far too many re-alignment surgeries fail to address the problem of aggravation at a cellular level in the synovium under the patella. He thought that I should have a synovectomy (where they remove the syovial lining), and that should help me. It is a different way of looking at the problem, I was always told my kneecaps were not aligned right. But he said that is not where the new research in this area is headed. I would reccommend you find an OS who specializes in the Patella/Femoral area. My old OS is a good surgeon, but he is a Sports Medicine Knee Specialist, and if something isn't broken he sees nothing to fix. I think when you feel your doctor does not have a plan anymore, it is time to seek a 2nd opinion. Take care, Kera

Offline cat

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Re: Should I search out another OS??
« Reply #2 on: June 28, 2006, 06:49:37 PM »
Kera,
Sounds interesting. I would like to see the research. Did your OS mention what the recovery would be like?

Mandy,
Sorry to hear about the continued problems. I'm always in favor of getting another opinion- unless you think it would jeopardize a needed relationship with your current OS. Did your doc have you set up another apt to see him?  Perhaps you could ask him if he thought it might be a good idea to get a fresh look from someone else. Maybe your OS would even give you some names. That's what my OS did. He gave me the names of locals as well as out of towners. He thought a fresh unbiased look would be the right thing to do. He discussed my case with his partner- 2 heads better than 1- who I saw yesterday. But I only had to be there for 3 hrs.  ;)  I had the exam and some more x-rays- laterals.  The OS took out a ruler and measured for infrapatellar contracture. Have you had that done?  He mentioned that my TT might not be fully healed and/or that I may have some scarring from where the VMO and medial reefing was done. In any event, he had some ideas to check into.

I looked at LaPrade's site. Is he affiliated with a Patella Femoral group?

Keep us posted and dont' be discouraged,
 ;D cat  ;D
"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-  3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Offline kera4

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Re: Should I search out another OS??
« Reply #3 on: June 28, 2006, 09:45:08 PM »
Dear Cat and Mandy, The second opinion OS is Dr. Scott Dye and his website is www.kneeexpert.com. There you can see all his research about the patella. He told me that the synovectomy would be two weeks of resting/icing, and then 6 weeks of taking it easy and doing gentle PT. He also said that I should stay overnight in the hospital with a drain after the procedure. He feels that there was excessive bleeding with my lateral releases (outpatient procedures) that probably caused the scar tissue. I am still thinking about this surgery. I might get a 3rd opinion. After so many surgeries, I am afraid to make things worse. I just want to be sure before I jump in again.

Cat, did the cortisone help your pes ansernine? I too have had so much pain in this tendon/bursitis area! It seems that people with patella traking problems seem to get pain in this area. Take care, Kera4

Offline Janet

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Re: Should I search out another OS??
« Reply #4 on: June 29, 2006, 12:18:47 AM »
Mandy:

I think it's always a good idea to get a second opinion if you feel your OS isn't really listening to you or giving you reasons behind their treatment plan. It doesn't mean you are changing doctors, necessarily, just getting another opinion. Your OS should welcome the chance for someone else to look at your knee.

I have found that when I stayed with a particular OS for a longish period of time and things were not moving forward, they were usually already sure in their mind what the problem was and weren't looking at the whole picture anymore. When you go for a second opinion, the new OS will give you a complete exam and start from scratch formulating a diagnosis. In my case that has always led to something the other doctor had missed.

It sounds like you "know" that something isn't right and your OS isn't listening. That should be enough of an argument for seeing what someone else would have to say.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline cat

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Re: Should I search out another OS??
« Reply #5 on: June 29, 2006, 04:41:45 AM »
Kera,
I checked the link. Did you read any of the publications? Conscious Neurosensory Mapping of the Internal Structures of the Human Knee Without Intraarticular Anesthesia was especially interesting. The dude let someone scope and poke the inner workings of his knee without anesthesia! :o :o

As for the cortisone, it may have helped the bursitis a bit. I'm not really sure. The shot didn't fix what I wanted it to fix.
 ;D cat  ;D
"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-  3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Offline Mandy

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Re: Should I search out another OS??
« Reply #6 on: June 29, 2006, 05:15:26 AM »
Thank you Janet, Kera, and Cat for your posts!! :) kera the articles were very interesting..thanks!!

so, I talked with the parents today and we both were on the same page, which is good.  i told them about my ideas to see this OS in Minneapolis at the U of M campus.  we all checked out his publications, as well as his site he set up through the University.  all three of us came to the conclusion that it was time for maybe a fresh pair of eyes. 

like you said Janet, a new OS will give me a full knee exam and make his own diagnosis.  he won't be so concentrated on the whole tracking issue which has been fixed.  hopefully he'll pay attention to that darn joint line pain.  long story short, I called the campus today and asked if he was taking new patients.  i had to tell the nurse all that has been going on with my knees, as well as all the surgeries i've had.  after she heard i've had the 5 surgeries (told her the procedures i've had done) and am still in lots of pain, she was like "ok when do you want to schedule?" :)  They actually had an appt for tomorrow but I had to decline just because I didn't have any of my records in my hands.  The next available appt. was July 21st....so thats when I'm going.

I'm of course not looking for a miracle or anything.  I just want another person to check things out and get their opinion, and decide what to do after that.  Theres just something my OS isn't telling me and it doesn't feel like some things should be the way that he says they are.  Granted this new guy will look at my old records but I'm sure he'll see everything for himself.  :)


one quick question:  how long should i wait from the appt i had yesterday until I ask for my records??  i don't want to ask too soon that they'll be sitting on his desk waiting for dictations.  how long does it usually take for records to be sent to a patient??


~Mandy

« Last Edit: June 29, 2006, 05:25:12 AM by Mandy »
21 yrs old
12/04: plica removal (RK)
2/05: debridement, LR/TTT (RK)
6/05: debridement, LR/TTT (LK)
10/05: scar tissue removal/debridement (LK)
3/06: screw removal (both knees), debridement on TTT site (LK)
5/08: debridement, HTO, Maquet procedure (LK)

Offline sharon74

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Re: Should I search out another OS??
« Reply #7 on: June 29, 2006, 05:21:41 AM »
I am glad that you and your parents are able to agree.  It is tough when you have pain but your family does not comprehend it.  Good luck to you!!
1990 - left knee exploratory - removed scar tissue
1991 - left knee LR
1993 - right knee LR
2002 - left knee LR
2006 - left knee TTT/LR

Offline kera4

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Re: Should I search out another OS??
« Reply #8 on: June 29, 2006, 06:48:23 AM »
Dear Mandy, When I have asked for records, it usually took about a week for me to receive them. To get your MRI's and Xrays, you or your parent/spouse have to sign for them, at least that is how it is in California. I found the most important piece of information for second opinions is the MRI's and Xrays. It is such a good idea to get a second opinion! Before I did, I felt really depressed, like I had no options. At least now I have a new idea that I can consider.

Isn't that article wild about having your knee probed with no anesthesia? I also liked the one about the "envelope of function." Dr. Dye explained to me that with patella problems, all it takes is a little bit of activity past how long you can stand/walk and it is like a light switch: you can get excruciating inflammation!  Something about the cells in the synovium going into biochemical imbalance. Anyway, food for thought.  Good luck, let us know how your second opinion goes....Kera

Offline Leentje

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Re: Should I search out another OS??
« Reply #9 on: June 29, 2006, 09:26:14 AM »
Mandy!

my advice?

If you see the new OS then first tell him what pain you have and let him examine your knee BEFORE you let him look at your records!!! You can tell him what surgery you had but don't show him the details!

From one who has been working with OS/drs for ages! ;)

Helena
Bilat patellar malalignment/PFdysplasia
00/06/83 L wrist #
11/12/00 L knee LR + chondroplasty
21/08/02 L knee TTT
02/03/04 L knee stretched PCL
11/09/07 L ankle dislocation/medial avulsion #
25/05/09 L ankle medial avulsion # AGAIN!
05/06/13 R ankle dislocation

Offline lgeorge106

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Re: Should I search out another OS??
« Reply #10 on: June 29, 2006, 11:49:30 AM »
I have to agree with Helena on this one.  Too many doctors (at least in the US) are afraid to go "against" another doctor's diagnosis.  Tell him the surgeries, etc., have him examine you, and then give him the rest of the records.  Even drs in different practices may stick to the "code".

My second opinion doctor became my primary OS after my first appointment.  He took the time to examine me, review my records, take his own x-rays, had a better bedside manner, and didn't make we wait 2+ hrs in the waiting room for a 2 min visit.  Now my new OS spends almost 30 min with me every visit, knows I come with a list of questions, and takes the time to explain everything, isn't afraid to tell me he doesn't know something, and I've never waited more than 30 min to see him.  His diagnosis was similar to the first OS, but sounded more promising.  The first OS told me I had knees of an 80yr old (I'm not 40 yet!) and try more drugs.  The new OS said there wasn't any arthritis and did a LR.  I did develop a little arthritis between Dec and Mar scopes, but no where near 80 yr old knees. :^)

Good luck with the appointment!

Lisa
1984 - L knee scope
1985 - L knee LR
12/15/2005 - R knee LR
03/14/2006 - R knee chondropasty and synovectomy

Offline Janet

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Re: Should I search out another OS??
« Reply #11 on: June 29, 2006, 03:25:42 PM »
Mandy:

Chances are the new OS won't want to see all your records. Did they tell you what to bring? If they didn't, I would only bring your surgical reports, written reports from any x-rays, MRIs, etc., and the actual films from your newest ones. Also the notes from your last doctor visit.

As for getting those last notes, call his office and ask the procedure. Different places have different sets of rules. I have been able to fax a request and I have been asked to come in person to sign a request. I have had them faxed back to me within hours and have had to wait a couple of weeks. So call and ask so there aren't any surprises.

Don't be surprised if you take all this stuff with you and the new OS doesn't really look at it. He will probably take his own x-rays even if you bring some with you. You really want him to be looking at it freshly, and only referring to the old records for background.

I'm glad you're moving forward with this. Good luck on the 21st.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline Mandy

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Re: Should I search out another OS??
« Reply #12 on: June 30, 2006, 06:07:38 AM »
thank you so much Janet, Lisa, Helena, Kera, and Sharon!!! :)  i really appreciate all of your input.

I understand where both sides are coming from about the records thing.  I don't want this new one to get into the same frame of mind as my current OS.  But I do feel that he has a right to know what I've been through, in hopes of him formulating what I should do next to get back to normal.  I have planned on giving my records to him, as all my records and films were requested. 

I'm not too worried about him formulating anything before actually looking at my knee.  In all honesty, he won't have enough time to look at all my records right before my appointment.  (I'm just supposed to bring everything with me when I come for my appt...so no sending stuff in so he has time to look at them).  I guess if he brings stuff up from my records, I can tell him how I feel about the OS and how i felt he wasn't understanding and really listening to me. etc.  ;)

I'm at my OS's office next week Thursday for a massage therapy session so I think I will be asking for my records then, so I can perhaps get them by the week after.  That gives me plenty of time to get things in order, as well as reading my reports that I've been antsy to read!!! :D  Hopefully things work out so that my current OS doesn't know about this 2nd opinion.  I just don't want him knowing at the moment in case things don't work and I have to stick with him for a little bit...hope that makes sense. 

Thank you all again!
~Mandy :D
21 yrs old
12/04: plica removal (RK)
2/05: debridement, LR/TTT (RK)
6/05: debridement, LR/TTT (LK)
10/05: scar tissue removal/debridement (LK)
3/06: screw removal (both knees), debridement on TTT site (LK)
5/08: debridement, HTO, Maquet procedure (LK)

Offline jerman710

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Re: Should I search out another OS??
« Reply #13 on: June 30, 2006, 01:38:49 PM »
Hi Mandy,
      I hope you find answers to your ongoing knee pain on the 21st. I'll be thinking of you.

Take care,
Jerry
43 yrs old
6/21/05 arthroscopy rt knee meniscus tear
10/5/05 2nd arthroscopy rt knee another meniscus tear
2/15/06 Fulkerson, LR, debridement and yet another menscal tear Rt knee
10/18/06 microfracture right knee
10/23/09 debridement right knee
6/16/10 PFJR right knee scheduled

Offline Mandy

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Re: Should I search out another OS??
« Reply #14 on: July 03, 2006, 08:20:55 AM »
Thank you Jerry! :)

Well, only 17 days til the appt....but who's counting??  ::) :P  I've been getting nervous for this ever since I scheduled it!  I'm just anxious to hear what he has to say and hopefully hear an answer pertaining to, "I can help you". 

I think I'm still in the mode of wondering what's going on inside of my knees.  Something in there just really doesn't feel right, and working all this weekend has made me REALLY feel something isn't right.  Yet on some of my better moments, I almost feel like I'd be wasting this OS's time by having him see me.  Has anyone else felt this way?? ???

I just want to be able to move away from home in a few months, off to college, and be as pain free as I can.  My goal is to remain very active.  Working out really makes me feel great about myself, and I want to be able to get back to my instense workouts.  Even when I go for walks around the neighborhood or am working, I feel like a 120 year old. 

Just frustrated about not being able to do the things that I love.  Is it normal for me to feel this way about this OS?  (part of the time excited, and other times scared to death that I'm just wasting everyone's time??)

Thanks everyone,
~Mandy :D   
« Last Edit: July 03, 2006, 08:26:25 AM by Mandy »
21 yrs old
12/04: plica removal (RK)
2/05: debridement, LR/TTT (RK)
6/05: debridement, LR/TTT (LK)
10/05: scar tissue removal/debridement (LK)
3/06: screw removal (both knees), debridement on TTT site (LK)
5/08: debridement, HTO, Maquet procedure (LK)