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Author Topic: Decision on surgery  (Read 577 times)

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Offline modingle

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Decision on surgery
« on: December 08, 2008, 04:37:24 PM »
Hi all - am new so be gentle with me  ;D

I have been experiencing bad knee pain since earlier this year - the pain got so bad that in early April 2008 I had to get signed off work and I had a steroid injection and fluid removed by my GP and was prescribed Naproxen for pain relief.  The injection did not bring any relief and I was referred to an OS.  The appointment took 18 weeks to come through - I attended clinic and OS had a quick look at my knee and sent me for an x-ray.  He advised x-ray was inconclusive so I was referred for an MRI scan.  This appointment also took several weeks and I eventually had my MRI scan done 29/9.  I was advised I would hear from OS in 2-3 weeks about a follow-up appt - I waited 4 weeks and heard nothing - I called OS secretary to find out what was happening and they told me they could not find my MRI results - I was actually asked if I had indeed attended for the scan !!!!!!  The secretary took my number and called me back several hours later to advise she had tracked scan down but it had not been 'signed of' by a radiologist ???  I was then told I would now get an appointment for 2/3 weeks later to discuss results with OS - 2 weeks later nothing had arrived so I called OS secretary again - this time I got a different lady who again advised me there was no record of my scan in my notes !!!!!!!!  She went off to track it down and she called me back the next day to say she had located the scan and my OS had had a 'quick look' at it and they would now be making an appt for me to attend a OS clinic but the waiting list was 6-8 weeks.  By this time I had had enough and called my GP for advice on what to do - he advised making a complaint to my local NHS listing the above dates and phone calls etc - I did this and sent him a copy as well and he said I had put my complaint very well.  Despite a promise of a reply within 20 days I only received a reply this week 4 weeks after making initial complaint and this was just advising they were still looking into it !!!!!!!

In the meantime I have had my appt with OS and he said MRI scan showed no cartilege damage and that it was wear and tear on my joint - he advised I was too young at 45 for a knee replacement.  He told me about an osteotomy procedure and explained what it involved.  I asked if he did not carry out this procedure was there anything else I could do - I'm now using a stick to help me get about - his answer, keep up with the painkillers, try taking glucosamine, lose weight and keep using the stick !!!!!!!

I told him that although I am overweight (I need to lose about 3 stone)I have lost over a stone in the last 6 weeks and am still weight watching - it is very hard to lose weight when you can't swim, attend gym, walk etc but I am managing it.

He said he would have to discuss doing the operation with his colleague and would let me know the outcome.

I received a letter today advising that due to my weight they will not be carrying out the operation but wishing me success in my weight loss and to contact him again in the future if I needed to - I feel devastated by this response - no-one wants an operation but I can see no end to this and I am extremely depressed.  I came across this forum and am glad to be able to 'vent'

Thank you for reading my post

Offline Marjan

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Re: Decision on surgery
« Reply #1 on: December 08, 2008, 06:54:59 PM »
Hello -

I'm so sorry that you've had so much trouble with your attempts to get some medical attention.  I'm in the US and don't know anything about the NHS, although I'm sure there are tons of people here who do know.  I would be terribly put out if my MRI scans were "lost" twice!  And all the waiting you've had to do hasn't helped anything, although it does sound like you are on a great track for losing weight.
There are a couple of things to think about.  Is it possible that the complaint you lodged at NHS went to the OS and he choose to not treat you for that reason? If so, you need to find another OS.  Your GP sounds like someone you can work with and I would schedule an appointment with him and ask for his recommendation.  You need a plan of action at this point.  Again, I'm not sure how the NHS works, but a second look at your MRI would not be amiss. 
You can also look around this site for "osteotomy", or maybe TTT....or anywhere in the arthritis section where it talks about "changing the forces through the joint".  I personally don't understand that you have no cartilage damage, but wear and tear (wear and tear usually is cartilage damage, I thought....but, I may be wrong).  So, armed with a bit more information, you could maybe ask your GP to refer you to a physio.  Losing weight is tantamount (oh yea, I'm right there with you) as is getting the joint to keep moving and stronger.  If physio is not an option, look into getting into a pool to do some water walking, or swimming. What you want to do is exercises that don't involve complete weight bearing, but strengthen the muscles in your thigh (quads/hamstrings).  After exercise, icing the knee helps keep inflammation down and generally it's good to put that knee up!
Many of us on this board have gone to multiple orthopedic docs.  Not sure whether it's just the orthopedic specialty that attracts the type of doc that just would rather be in surgery than talking, or heaven forbid, listening to a patient, but it may take a while to find a doc that you can relate to and with.  This also puts the onus on you. You've got to think like they do.... They don't live in your body and don't know your pain.  It helps to write things down, specific pains after specific incidences.  What you do that makes it better, what aggravates it.  Commonly, the docs are generally not interested in life stories...they have limited time per patient and want to get down to the "meat of the matter".  So, do your homework, get to know the ins/outs of knees and the musculature around it.  You're more apt to get him/her to listen to you if you say " my patella tendon pulls when I walk fast", compared to "well, it sorta hurts kinda down here".
You are your own best advocate.  I love the fact that you've already lost a stone and are on your way to losing more.  Don't give up on that!!! You CAN do it and your knees WILL thank you for losing weight. Stay upbeat, be kind to yourself and KNOW that you deserve good medical attention and to have every avenue looked at to relieve your pain. 

all the best,


Offline jathib

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Re: Decision on surgery
« Reply #2 on: December 08, 2008, 07:29:58 PM »
So much for "free" medical care. In the US we would simply find another doctor. There are some that think 45 is too young for a knee replacement but more and more have begun to believe that quality of life is more important and they do replacements at much younger ages. But you must go into it knowing you'll probably need a revision at some point.

An osteotomy is a good option if you only have damage on one side of your knee. If it's both sides then it can't be done. There's also a partial knee replacement that can be done. I had mine done at age 48. An osteotomy is usually done on "younger' patients. My doctor said I was what they called a "tweener", meaning I was at an age where I could do either the osteotomy or PKR.

At any rate, swimming is a great way to lose weight. You should be able to do that with a bad knee. i was always able to swim and bike with a bad knee even when I couldn't do anything else.