Advertisement - Hide this advert





Author Topic: Update and Synvisc Questions  (Read 2477 times)

0 Members and 1 Guest are viewing this topic.

Offline pdlucky

  • MICROgeek (<20 posts)
  • *
  • Posts: 14
  • Liked: 0
Update and Synvisc Questions
« on: July 11, 2012, 09:41:01 PM »
Well my journey with osteoarthritis will be a year post complete lateral menisectomy in November and have grade 4 arthritis on the end of my femur and the end of my tibia and grade 3 under my kneecap.  In January I made a serious lifestyle change and made a commitment to myself to get down to a healthy BMI.  I am not there yet but I am only 9 pounds away from the healthy BMI.  I have lost 100 pounds so far.  I quit eating sweets on January 1st and I have been swimming laps Monday through Friday before work.  I have really learned a lot about myself and how to live healthy with portion control and exercise.  Here is a comparison picture:


So with the update out of the way, on to the questions.  As of recently I have been having more and more knee pain which seems opposite of what should be happening.  Now more so than before I have knee pain while swimming.  It isn't hurting bad enough to make me stop swimming but it has put the thought in my head.  I was thinking of getting a bike but I feel that if swimming which is no impact no weight bearing is hurting then I'm not sure a bike will be a good idea at this point.  I also notice now that I am having an increased amount of pain when walking and really a general more soreness in the knee.  This blows me away I would have figured that loosing the weight would have made it feel better not worse.  So have others found that their pain increased as their activity level increased even though you have only been doing approved exercising?  Also I am really considering going back to my surgeon and discussing synvisc injections.  According to my surgeon the injections cost $1200 a pop here in the USA, and that they typically only last 3 months and a lot of people end up getting them every month.  I am 37 years old and have been told that I will have to live with this knee until I am in my 50's I do not see how I can possible pay $4800.00 a year for the next 13 years seeing that I have a $3000 deductible each year.  Are the synvisc injections worth it? 

I currently wear the Duo by Bledsoe unloading brace and it has helped me be more mobile and I am not walking with a cane anymore.  These things are all great but the new increase in pain is concerning to me.  Has anyone else experienced increased pain when you were expecting a decrease?

Offline dm

  • SuperKNEEgeek
  • *****
  • Posts: 1304
  • Liked: 19
  • I hate my knee!! :(
Re: Update and Synvisc Questions
« Reply #1 on: July 12, 2012, 03:53:35 AM »
congrats on the weight loss! you could have developed an issue that's causing the pain, like something torn in there, if you haven't had an mri in a year, may be time for one to see where things stand. I'm 40, and looking a TKR square on... nothing else left. Just went through 5 hyalgan shots - another variant of synvisc. If these don't help relive my daily pain... nothing else left to do. I'm living in a G2 unloader, have a partial acl tear that was repaired and retore 14 mos after repair, have grade 4 patellofemoral compartment, grade 3/4 medial, and one OS I've seen says my MRI looks like I have another meniscus tear on the medial side. An OS I saw for a 2nd opinion says it's pointless to scope for the meniscus tear when the acl is so loose and the arthritic damage is so bad.. the root cause of pain will still be there after. He said try hyalgan to try and buy some time and get some pain relief, otherwise end up going for tkr...

so... long and short of it is that I am in about the same place you are, but just a few years older. They can do a TKR at our ages, if there's enough damage to warrant it, and there's no other options left... I went and did the one round of shots, so when the doc goes before the insurance to get approval for the TKR... we can say we tried that....because you know how the insurance companies are... they'll insist that you have tried all the cheaper alternatives first - like they do with meds.
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline pdlucky

  • MICROgeek (<20 posts)
  • *
  • Posts: 14
  • Liked: 0
Re: Update and Synvisc Questions
« Reply #2 on: July 12, 2012, 03:43:19 PM »
Thanks for your comment.  I took a turn for the worse this morning.  As I left the house I remembered I needed to go back in so I squatted a little to set my bags down and I guess I must have started to turn at the same tie and BAM down I went in bad pain.  I could not go swimming and am walking with my cane and sitting at work with ice on my knee whishing I had brought the heating pad.  Looks like the trip to go see my OS will need to be soon.

Offline LAS

  • Forum Faithful
  • ****
  • Posts: 250
  • Liked: 11
Re: Update and Synvisc Questions
« Reply #3 on: July 13, 2012, 02:08:39 AM »
Hi Pdlucky:  I had the synvisc injection in my left knee after surgery.   I was limping and could not get up and down stairs very well.  Also after the surgery my knee was giving out so I was afraid to do anything at all.  After the injection there was a 40-50% improvement, not great but better.   I can climb the stairs without doing the heaven and hell walk or holding on to the railing.  I can squat and kneel  better and I dont limp unless I stand or walk for long periods of time.   If I had to get the injection again I would.   I think you should do anything you can before getting a TKR.   Hope this helps you and be careful I know the feeling when your knee can give out at any time without warning, it can be dangerous.    LAS

Offline LindaM

  • Forum Faithful
  • ****
  • Posts: 488
  • Liked: 8
Re: Update and Synvisc Questions
« Reply #4 on: July 13, 2012, 02:47:17 AM »
Hi there,

Congratulations on getting your weight down.  Right now you may not notice it helping your bad knee, but it will certainly help your good one to last.  you described yourself as having grade3/4 arthritis.  I agree with dm that you would be wise to make an appointment and get an xray and an MRI.  A synvisc shot doesn't do any good if you are bone-on-bone, and you won't know that unless you at least have an xray.  I speak from experience, my knee was pain-free before I tore the meniscus and after my meniscus trim my knee went straight downhill to bone-on-bone and a PKR.  Hopefully you still have cartilage left and be a candidate for a try at synvisc.  If it works, it can last for 6 months to a year and for some people longer.  I had the one larger injection rather than the series of three, and it really wasn't any big deal to have it- I just wish it had worked. When my second knee started to go my rheumatologist tried cortisone injections instead of the synvisc.  He went to a conference a year ago and one session was on a comparison of synvisc vs. cortisone injections for advanced knee arthritis.  According to the research presented there was no difference between the two for success, but the cortisone is cheaper.

Good luck and good healing. :)

Linda
>20 yrs. osteo and inflammatory arthritis, fibromyalgia
meniscus repair Sept. 2009
right PKR June 2010
left PKR Feb. 2012

Offline LAS

  • Forum Faithful
  • ****
  • Posts: 250
  • Liked: 11
Re: Update and Synvisc Questions
« Reply #5 on: July 13, 2012, 02:19:11 PM »
Yes I am with Linda M.   I recently had a second opinion with a OS in Boston for a tear in the R knee.   I did have a cortisone injection in my right knee that worked almost immediately and still feelling the benefit.   He told me there is no reason why I shouldn't be able to get cortisone instead of synvisc and that recent studeies showed there is very little difference except price.   I think most OS' s here will  try the cortisone first to see how you do. Why he gave me synvisc first I'll never know.    I hope this helps you.   LAS

Offline pdlucky

  • MICROgeek (<20 posts)
  • *
  • Posts: 14
  • Liked: 0
Re: Update and Synvisc Questions
« Reply #6 on: July 13, 2012, 04:51:29 PM »
First off thanks for the replies!  I went to see my OS yesterday and he thinks I chipped a piece of the cartilage off.  He siad there isn't any meniscus to tear in there so he felt pretty confident after examining me that it was just cartilage.  He said that the ligaments are "grossly there" (there was signs of previous ligament injury so they are not the healthiest but they are intact).  He gave me a steroids and novicane injection in the knee and said I would get 4 to 24 hour of relief from the novicane and on Sunday I should start to get some relief from the steroids.  He said I could get up to six weeks of relief from the injection once the steroids kick in.  I woke last night in some good pain so the novicane is worn off.  The OS wants me to go back in for standing x-ray's and depending on how the x-ray's look will determine our next course of action.  He said if the x-ray's show me bone on bone then he will want to do a PKR however looking back at the pictures from the last time he was in there he needs me to "really pay attention to where I have pain."  Do to the arthritis under the patella he does not want to do a PKR if there is pain or discomfort from the patella.  He would rather do a TKR because he would most likely be back in there in a year from the pain from the patella.  If the x-ray's do not show bone on bone yet then he thinks it maybe time to go back in and do another scraping and if I am still in pain from the chipped cartilage he can hopefully find it and remove it.  His thinking is if he can do another scraping and buy me another year then he will need to do it.  He then will want to try the synvisc injections but he really knows that any of these things we try is not going to give me more then a couple years and he really doesn't beleive I will get any better then were I was at before this new incident "if it gets back to that level."  Do to me only being 37 the insurance companies will not authorize the replacement until he tries all other options and buys me as much time as he can.  I really don't know what to hope for on the standing x-ray's I feel like I would rather the replacment be done if I am going to get relief from it.  Even after taking the weight off, which the doctor was so impressed, the pain is more than I really want to go through till I'm in my 50's.  I know quit whinning right :-) I am keeping my hopes up that come Sunday the steroids will give me some much needed relief!  I really do not want to go back under the knife again especially since the last scraping was in October 2011.  Not even a year later and he is talking about doing it again.  Is this common for others to need to have scrapings done so soon after the first one? 

Offline LindaM

  • Forum Faithful
  • ****
  • Posts: 488
  • Liked: 8
Re: Update and Synvisc Questions
« Reply #7 on: July 15, 2012, 12:51:48 AM »
Hello again,

Sounds like you have a surgery in your future either way.  I'm glad to hear your OS is doing all the little steps first, but being very honest with you.  I have had some cortisone shots that have lasted over a year, so hopefully yours will give you relief for quite a while.  Just be careful that you don't overdo just because you feel better for a couple of days.  The longer you can keep the cortisone in the joint the first couple of days by taking it easy the more it will help.

 Hopefully when it comes to that time you will be able to have a PKR instead of a TKR.  It is a much quicker recovery-I was back to teaching full time in 6 weeks- and since you are so young and will need your knee done again at least once, your PKR revised to TKR gives them more bone to work with for a second TKR.  That being said, it is in your best interest to keep your own joint as long as you can until the pain is truly intolerableIf you can get relief from the shots, even to cutting your pain in half, I would go for it.  Have you considered an unloader brace?  I found it was helpful although not enough for someone like me who is on my feet all day teaching.

Are you working on any exercises to strengthen everything around the knee?  Its good to hear that things are grossly intact, but it might be worth the effort to get stronger and hold everything together a little tighter.  I think you are wise to choose exercise like swimming to take it easy on your knees, but more targeted exercises might be needed.

Good luck, and keep updating your progress.  We are rooting for you. :)

Linda
>20 yrs. osteo and inflammatory arthritis, fibromyalgia
meniscus repair Sept. 2009
right PKR June 2010
left PKR Feb. 2012

Offline dm

  • SuperKNEEgeek
  • *****
  • Posts: 1304
  • Liked: 19
  • I hate my knee!! :(
Re: Update and Synvisc Questions
« Reply #8 on: July 15, 2012, 01:29:08 AM »
With having had the cortisone shot, ice the knee on and off every couple hours or so, it helps with the discomfort from the cortisone as it kicks in to reduce the inflammation. When your doc does the standing xrays, ask him if he's going to do the view through the knee, showing the kneecap placement with the knee bent. that one shows where the kneecap sits with the knee bent, and can tell them a lot about the state of the patella/femur compartment. (mine's shot, so PKR is not a choice)

As your doc said, and as I pointed out - because of being a younger patient with a knee that's fairly shot you've gotta show that you've gone through all the "reasonable" options could be considered to the point where there's nothing else they can do to make you functional BUT do the TKR. Which is why I went through with the Hyalgan (aka Synvisc) shots. I've already had 6 knee surgeries since 2000.... and I've got a stack of MRI's, photos, etc that show my functionality is only getting worse.

I mowed the lawn today... that is ALL I did... and I'm in so much pain with my knee I'm hobbling when I walk, and even my ankle hurts! I've had one percocet, and am trying to put off until later taking a second max dose of 2 at once.... and I've had ice on the knee constantly since I came in from outside. My unloader brace is soaked in sweat, so I had to take it apart and put the pads and straps in the wash, so I've got my leg all strapped up in my old postop brace to keep my knee stabilized and supported and I've got a big bag of ice on my knee with that. Even with all that hardware with this big Townsend ROM brace on it... I STILL hurt just to move around the house for the "essentials". I'm not doing anything else the rest of the weekend....I've gotta let the knee recover so I can work on monday....

You can imagine, from your experiences, how much it SUCKS to be able to do so little.... to find yourself so incapacitated after doing a chore that takes an hour or so... yet basically puts you in bed for 2 days recovering from it. It's so FRUSTRATING!! >:( >:( >:( Some days at work feel almost like this... but I still have to get up and go to work the next day. Nothing else to do but suck it up and go. Only "blessing" I've got is that being a rockhead, the painkillers don't mess me up cognitively, so I can take them and function. I never wanted to discover through experience that they could give me 3 different narcotic painkillers via 3 different administration routes (IV, IM, and oral) within a 2 hr time span, and still not be mucked up in the head.... I got sent home from the hospital after surgery on crutches with that much painkiller in me and all that didn't even put me out!

I am in the same "boat" you're in - I just want the knee to function, to not hurt so bad that it feels like someone's in there with a grinder filing on my bones, and to get through the day without having to be forced to resort to the painkiller bottle to stand being in my own skin. I don't WANT to be dependent on painkillers, but like you, I too, am forced to go through the "system's" hoops to make them see that the TKR is the only choice left. Gotta dot the "i"s and cross the "t"s.... and have an OS that will be on your side against the insurance company.

You might ask your doc about Lidoderm patches for the knee pain... they don't take it all away, but if you put one across the front of the knee, and a bit to the bad side, it can "dial it down" a couple notches on the pain scale... not complete relief, but a help. One patch is good for 12 hrs.... Might be worth asking if you can try them. You may have to play around with the placement a bit to find what helps you best, but across the front of the knee right below the kneecap helps me a fair bit - unless I've REALLY overdone it, of course.

multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline pdlucky

  • MICROgeek (<20 posts)
  • *
  • Posts: 14
  • Liked: 0
Re: Update and Synvisc Questions
« Reply #9 on: July 16, 2012, 04:06:43 PM »
Great info thanks everyone.  I am in an unloader brace and it is helping to an extent.  I got back in the pool today and swam for 30 minutes but was not able to kick that leg.  I am now in my office in some pretty excruciating pain and I feel like the steriods have not given me any relief. MY OS said the steroids would start to kick in on Sunday and here I am Monday morning with no relief.  Everytime I moved last night it woke me up, and now today I am trying to figure out how I am going to make it through the work day and I have an office job so its not like I am even having to be on it. 

This is no way to have to live!

Offline dm

  • SuperKNEEgeek
  • *****
  • Posts: 1304
  • Liked: 19
  • I hate my knee!! :(
Re: Update and Synvisc Questions
« Reply #10 on: July 17, 2012, 02:34:01 AM »
I totally agree. When your knee is ruining your ability to do anything, something needs to be done... I'm in that boat too. I've got to wait for another 3 weeks, then they'll try a cortisone shot on top of the Hyalgan... and if things are still running about the same... then they'll call the shots a failure, and they can axe that off the list as "tried and failed" to add it to the list of things to cite when they do end up putting in for the approval for my TKR, along with the extensive list of the damage to my knee.
multiple arthroscopies 2/00,3/01,6/01,1/03, 12/07,10/10. chondromalacia, severe medial joint space narrowing following 3 partial menisectomies, chronic pain problems, kneecap problems, OCD lesion, failed mfx.

Offline LAS

  • Forum Faithful
  • ****
  • Posts: 250
  • Liked: 11
Re: Update and Synvisc Questions
« Reply #11 on: July 18, 2012, 02:08:46 AM »
Good luck pdlucky and good luck dm.   I 'me sorry that you are in so much pain and that it is taking so long to go forward.    Whatever  happens I wish you both to be able to walk without pain soon.    LAS















support