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Author Topic: Updated opinion on Dr Noyes?  (Read 226 times)

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Offline tonightmrkite8

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Updated opinion on Dr Noyes?
« on: February 26, 2020, 09:39:32 PM »
Another newbie to this website posting.

37/m. Was very athletic before this injury. A decade ago I spent years on the national rowing team and rowed at the world championships.

ACL/meniscus tear 5/19. Recon 6/4. Lysis/MUA 7/19 and 10/22. Local Pittsburgh OS. The latest surgery involved lateral and medial capsule releases.

After the most recent surgery I achieved 135 (sometimes even more)/0 extend. However, my knee continued to be hot and irritated. I felt a pop in mid-January while stretching my quad. MRI mid-February discovers that I tore a hole in my capsule. There's a huge cyst of joint fluid rising above the  area where the lateral release occured.

After immobilizing for 10 days, my knee stiffened up and I lost a ton of ROM. My local OS basically said he can't do anything else for me. Referred me to Noyes in Cincinnati.

Some questions here:
-I've read positive reviews of Noyes, but also see that he's old. Has anyone else experienced his care firsthand (lately)? Did it make you concerned?
-Are there other doctors within 6 hours of Pittsburgh that I should consider? What about someone else? I see Singleton in Texas mentioned frequently.   
-I do massage, ice, ART, stretching. My pain is manageable right now, so I'm not on heavy pain meds. However, if I do any leg specific exercises, I am in debilitating pain.
-I have changed my diet - no gluten, dairy, or sugar (glass of wine every now and then)
-I am seeing a frequency specific microcurrent therapist tomorrow in hopes it will help.

Apart from doctor suggestions, is there anything else I should be doing?

Thanks

Sam
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Offline DogfacedGirl

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Re: Updated opinion on Dr Noyes?
« Reply #1 on: February 28, 2020, 01:47:23 PM »
Hi Sam,

I believe I heard a while ago that Noyes has retired, perhaps somebody else can confirm that? As you say, Singleton is mentioned a lot. However, it's probably unwise for you to rush into more surgery at this point because you are still in the early days of recovery, even if it doesn't feel like it. Unfortunately every time you have surgery on your knee there is a greater risk of your knee getting worse, not better, thanks to the memory of the insult that stays there. I can explain more if you would like.
This applies regardless of how good the surgeon is, because surgery will stimulate the healing response and the inflammation all over again, and it is these things that are currently dysregulated and out of control. In addition to deceased ROM many people suffer permanent nerve damage from repeated surgery, and the pain that comes along with it. Nerves can also develop fibrosis.
Iíll outline some general advice, let me know if you have any questions. Disclaimer, Iím not a physician, Iím a scientist, and if youíre taking medications or have other health issues you should check with your GP before doing any of these.
Firstly, if your knee is warm and puffy, you should ice and elevate as often as possible during the day. If youíre taking NSAIDS such as Nurofen, Celebrex or Ibuprofen, stop. Taking these for more than a few days increases inflammation because they prevent the production of resolvins (necessary for putting the brakes on inflammation).
Second, if you can, take low dose aspirin at 80 or 100 mg/day and high doses of fish oil (omega 3 fatty acids). Aspirin works differently to other NSAIDS and increases the production of resolvins, which are made from omega 3's.
If you can, get a prescription for Metformin at 1 500 mg/day. This should help reduce inflammation. Corticosteroids are the usual standby treatment for AF, and you may have had these. It should help, but you canít have too much or you could end up with cartilage damage.
The next bit of advice is very important in my opinion. Never push your knee (during daily activities, physiotherapy or exercise) so much that your pain is increased afterwards, regardless of what anybody tells you. This is the major cause of relapse and return of symptoms even months after recovery, and can induce AF in a knee that has been doing well post-surgery. I quote one long-term AF patient: ďI am a year and a few months out from my last surgery.  If I remember right, my rehab protocol had me jogging around the 6 month mark or so...maybe even earlier.  No way could I have done that.  It has taken a LONG time to feel normal.  I'm not at all telling you this to frustrate you.  I'm pointing this out because it is so important to pay attention to how your knee is feeling and to make decisions according to how you are feeling.  I tried so hard to force my knee into being where it was supposed to be according to my protocols.  When I finally gave in and just did what my knee was capable of, it started calming down and improving.  Slow and steady really does win the race with this in my opinion...Ē I think this is excellent advice.
Next, if you can get a blood test to check that your iron, Vit D and potassium levels are OK, and a urine test to check your iodine. Many people with inflammatory problems are deficient in these, and they are crucial to a healthy immune system. I suggest you also take magnesium supplements, magnesium citrate is a form that the body can absorb (unlike the magnesium oxides that are usually sold). Unfortunately blood tests for magnesium are not very useful.
Stretching devices also seem to work if they are used every day. In the US there are several hand operated devices available, but in my opinion the motorised CPM does a better job and is better controlled. You will need to use this a lot to gain benefit, at least twice a day in the early stages, so if you can buy a used one from a hospital on Ebay that could be a good option. You can judge how long you need to spend on it for each session. The main caution here is to be very careful to not bend or straighten your knee beyond what is only mildly uncomfortable, if you tear something in your knee it is a major setback. The computer controlled CPMs have an emergency button to quickly lower the amount of ROM, and I suggest you always hold the controller. Stay at the same setting until your knee feels comfortable with it, then increase the degrees by 1 degree only, never more than that. And never strap your leg of foot in.
Another thing you could try is eating 100 g of 3 day old broccoli sprouts per day. These contain high levels of sulforaphane, and there is a lot of research that shows that this is a very powerful anti-inflammatory (check out Dr Rhonda Patrick on Utube). Unfortunately the shop bought ones are frequently contaminated, so itís best to grow your own. It is currently undergoing clinical trials for lung fibrosis, but hasnít been tested for AF, so I canít promise anything.
All the best,
Kay
1999 Osteoarthritis both knees, chondroplasty
2004 MACI graft L knee
2005 MACI graft both knees
2007 MACI graft R knee
2007 Patella baja
2011 TKR both knees
2011 arthrofibrosis

Offline tonightmrkite8

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Re: Updated opinion on Dr Noyes?
« Reply #2 on: February 29, 2020, 12:37:51 AM »
Gosh, what a great response. Really informative.

I asked my local OS to order the tests and I'm going to start growing my own broccoli sprouts. Also going to grab the other supplements. Do you suggest a minimum dosage of fish oil? I take 2x day normally. 

As mentioned in my earlier response, I did tear something about two months ago. This tear likely created a hole in my knee capsule. Do you have any advice as to how to heal this while avoiding my body laying down new tissue? Right now there is joint fluid leaking into the space around my knee - probably creating more inflammation. The usual solution is to immobilize the knee and hope the body heals itself.

I also wonder who I am seeing in Cincinnati if Noyes retired....I have an appointment at the clinic for this coming Thursday.

Thank you so much


Offline tonightmrkite8

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Re: Updated opinion on Dr Noyes?
« Reply #3 on: February 29, 2020, 12:52:54 AM »
Sorry about multiple responses. Would you recommend a particular knee bending brace or implement?

Thanks. Also happy to take my response in a PM.

Offline DogfacedGirl

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Re: Updated opinion on Dr Noyes?
« Reply #4 on: March 03, 2020, 09:05:36 AM »
Hi Sam,

Optiflex is a good brand that makes computer controlled CPMs, Kinetic is another one. The main thing is to have a hand piece with computer control so that fine adjustments to ROM can be made.

I can't really comment on the tear, but I'm guessing that your OS thought it would heal by itself, and I understand that this often happens. However, you won't be able to have it permanently in a brace, given the AF, so that does complicate things. Maybe a combination of using a brace with gentle CPM twice a day could work, but I'm not an expert on this. My feeling is that it would be best to give the knee a couple of months to see if it will heal, and you would need to be very certain (from MRI) that surgery is needed before you risked more surgery.

Kay
1999 Osteoarthritis both knees, chondroplasty
2004 MACI graft L knee
2005 MACI graft both knees
2007 MACI graft R knee
2007 Patella baja
2011 TKR both knees
2011 arthrofibrosis