Reevaluation?

[janq]

Four years ago I was dx with osteoarthritis of both knees.  Dr. said that I was walking "bone on bone" and that eventually I'd probably need tkr in both knees.  He advised using glucosamine chondroitin which I've done and for awhile it seemed to help. I was able to increase my exercise a bit and was walking more with less pain and swelling.  In the past few months  pain and swelling has increased which I attributed to less exercise and some weight gain, about 4 or 5 pounds.  I mentioned this to my pcp at my last checkup, but she didn't recommend any follow up but suggested that my arthritis is probably going to be my biggest problem.  I also have had trouble with my feet and podiatrist has fitted me with new orthoses which I've been using about a month.  He also says I have arthritis in my great toes along with bone spurs and gave me a cortisone shot in the one that was most troublesome.  It helped for about a week and I thought maybe the fact that I'd been favoring my right foot that it may have affected my gait and also placed more stress on my knees and hip.  ( I seem to have a sciatic nerve problem though it's not been dx.) I do have dbd in my lower back,  & a slight positional scoliosis.)  I'm wondering whether I should see the orthopedic surgeon for reevaluation or would another specialist for possible non-surgical intervention such as cortisone or other injection therapy be advisable.  I don't know who I should see for this type of therapy or does the orthopedic surgeon also do this.  With so many different specialties a patient really doesn't know where to turn.
Any help you can provide would be most welcome and appreciated.  

[Dr Vinod]

Dear janq,

Hello!

Osteoarthritis is a type of arthritis that is caused by loss of the cartilage of one or more joints. Cartilage is a protein substance that serves as a "cushion" between the bones of the joints. Osteoarthritis is also known as degenerative arthritis.

Aside from weight reduction and avoiding activities that exert excessive stress on the joint cartilage, there is no specific treatment to halt cartilage degeneration or to repair damaged cartilage in osteoarthritis for your stage of problem.

Applying local heat before and cold packs after exercise can help relieve pain and inflammation for you. Swimming is particularly well suited for you as it has                                                                                                                                                     minimal impact to the joints. Other popular exercises include walking, stationary cycling, and light weight training.
Use pain killers such as aspirin and acetaminophen (Tylenol) for treatment. New treatments include an anti inflammatory lotion, diclofenac (Voltaren Gel) and diclofenac patch, which are being used for the relief of the pain of osteoarthritis.
Non steroidal anti inflammatory drugs (NSAIDs) are medications that are used to reduce pain and inflammation in the joints. Steroids can also be used to be injected inside the joints by an expert.
Alternative treatment with the food supplements glucosamine and chondroitin could not relieve symptoms of pain and stiffness for you so a series of injections of hyaluronic acid (Synvisc, Hyalgan) into the joint can sometimes be helpful, especially if surgery is not being considered.

Surgery is generally reserved for those patients with osteoarthritis that is particularly severe and unresponsive to the conservative treatments. Total knee replacement is for the final treatment.

You should consult an Orthopedician and follow up on your Arthritis (knee and feet), Degenerative joint disease of the lower spine and also on your sciatica. If required you should also consult a neurologist.

Take care!

[janq]

Thank you so very much for your advice.  

Janq

[Dr Vinod]

Hello!

"Prolo" is short for proliferation, because the treatment causes the proliferation (growth, formation) of new ligament tissue in areas where it has become weak. Prolotherapy is often used as an alternative to invasive arthroscopic surgery.

Try to find out the clinic which has experience near your home town for consulting and understanding if it is possible for your knee problem?

I want to quote this:
As of April 2005, doctors at the Mayo Clinic began supporting prolotherapy. Mayo Clinic doctors list the areas that are most likely to benefit from prolotherapy treatment: ankles, knees, elbows, and sacroiliac joint in the low back. They report that "unlike corticosteroid injections — which may provide temporary relief — prolotherapy involves improving the injected tissue by stimulating tissue growth."

You have to understand that the response to treatment varies from individual to individual, and depends upon one's healing ability. Some people may only need a few treatments while others may need 10 or more. The average number of treatments is 4-6 for an area treated. The best thing to do is get an evaluation by a trained physician to see if you are an appropriate candidate. Once you begin treatment, your doctor can tell better how you are responding and give you an accurate estimate.

Take care!

[Dr Vinod]

Hello!

I am not talking about your Orthopedician who has specialized himself for knees. There are Orthopedicians who look beyond knees and arthritis, you can go to them or you need to go to individual specialists which will be cumbersome for you with multiple problems. You need to explain your medication and history to each specialist.

Orthopedician specialized for knees, Orthopedician specialized for feet, and Orthopedician/Neurologist specialized for back and so on.

Discuss with your original Orthopedist all your symptoms and if suitable he will refer to the best person possible. It is also worthwhile for you to do some research to find a good Orthopedician who deals with multiple disciplines.

Take care!

[janq]

Thank you for your advice which I will follow.

[Dr Vinod]

Hello!

I would still suggest you to discuss your whole case in detail and jot down points in a note and ask what best he can do. This would help for future problems.
You need a single specialist who would take care of all your problems, rather than taking multiple appointments.
Single pain killer to act against most of your pain related problems would also help you in limiting medications.

Take care!

[janq]

I will be seeing my orthopedist on Wednesday, Sept. 16...there was a cancellation and the receptionist moved my appt. from Oct.2.  

I'm concerned now because after suffering with pain for about 3 1/2 weeks, though I still have pain, now the pain is not as bad as it had been.  

What should I do?
janq

[janq]

I agree.  Fortunately, I've had doctors who are open to my questions and the research I'm prone to do in all things.  The only physician I've found a bit put off by this is my pulmonologist, but have found out from other physicians that he is this way with his coleagues as well.  It takes all kinds, I guess.  

[allmymarbles]

I note that it was you who brought up the subject of prototherapy. This confirms my belief that is is vitally important for a patient to be well-informed concerning his condition. Some doctors resent this, although Dr. Vinod, to his credit, with your best interests in mind, does not.

[janq]

Thank you for your reply.  I will follow your advice to discuss the multiple problems with my orthopedist.  BTW are you familiar with something called prolotherapy and if so have you heard whether it is helpful?
Thank you, again.

[janq]

Thank you for your response.  In your response you said.  "You should consult an Orthopedician and follow up on your Arthritis (knee and feet), Degenerative joint disease of the lower spine and also on your sciatica. If required you should also consult a neurologist."  The orthopedist with whom I've consulted about my knees doesn't do anything with spine or feet.  With whom would I consult about these...a spine specialist, a podiatrist?  

I have an appointment with the original orthopedist about my knees on Oct. 1...earliest appointment available.

Thank you again.