Sunday, February 06, 2011
I met with an ortho, Dr. Balis, at Cleveland clinic yesterday. I was very impressed with his determination to start fresh, and thoroughly cover how I got where I am. He obviously disagreed with everything that had been done around here by any and all dr's, but he reserved much criticism due to professional courtesy. Suffice it to say, I am shocked at some of the failings, and not by others.
We discussed the possiblity of knee replacement, but he said that in the case of a person with fibro it often does not go well to do a replacement. The pain of the surgery and the rehabilitation is typically too much. Therefore, the person is unable to do the rehab work; the knee basically seizes up; the scar heals hard; the skin has no stretch and the surgery was a wasted effort. So, for him, surgery would be the last choice and he did agree with trying to hold it off as long as possible.
His approach was multi-level. He said the Hyalgen shots I got last year were done improperly. They are to be given weekly for 5 weeks. I got them 3 increments spaced by 4 week intervals. His thought was that this would only buy me a few months at a time of relief, but better relief than I experienced last year with the way they were given. Of course, lose weight and go back to specific knee/leg exercises focusing on strengthening the calf and knee muscles for support.
I was diagnosed by The Arthritis Center in PGH with osteo-arthritis and fibromyalgia. Ortho said that rheumatoid arthritis can pop up over multiple testings and if it did, the shots are not recommended. His next step was he sent me to the next floor up to a rheum. dr. who confirmed again the osteo/fibro diagnoses and some term for the extreme pain felt with any pressure, forget what it was.
Then things got interesting. Dr. Yao did not agree even with the shots. His premise was that the shots are so painful that fibro patients get very little benefit. That is what I went through last year. By the time I healed from the shots themselves, I received little benefit. So, I tend to agree with him. He asked me to put the shots on hold for at least 6 months and give his therapies a try.
1. An additional anti-depressant to deal with both depression and fibro reactions.
2. Weight loss & the same leg muscle exercises mentioned before.
3. Sleep by 11:30 - for me, since 1/2 a.m. is more my typical bedtime.
4. Lighter supper (salad, little meat) when eating after 6pm suppers.
5. Hot showers, particularly before bed. - (jacuzzi tub or hot tub soak if you're that lucky!)
6. Insulate yourself from the cold inside/outside whatever it takes.
7. Be consistent with the motrin or whatever you take.
8. Use the cane, don't be too proud and don't take the chance of back-tracking with falls.
9. Walk in increments around on level inside, or slow on a treadmill if you have access.
10. Because of the arthritis and meniscus damage in my knee, he has ordered knee braces. Because the inside cartilage is much worse than the outside, he has ordered shoe wedges to change my gait more towards the better outside meniscus.
11. Keep getting tested for rheumatoid, stay on top of it in case it does pop up in the future.
He was adamant about something that sold me on everything he said. For once, a doctor said that stating all I needed to do was lose weight was crazy. He was very energetic about the fact that what I have is multi-faceted, complicated and very difficult to control. There is no cure for any of it. There is no restoring damage that's been done. And as I age, the arthritis will continue its path, so what to do is to do our best to deal with the disease and its damage as we go. I was in tears. For the first time, someone got it. AND my husband was there to hear it! Thank You, Lord!