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Knee & Hip Problems Message Board


Knee & Hip Problems Board Index


Re: Tkr
Jul 1, 2012
Thanks, Carol. I live in Colorado Springs, CO (yes, where the monster fire has been burning for over a week--more than 346 homes burned to the ground--I live a few miles from the fire area.) Your surgeon sounds wonderful--if I lived there I'd surely want him, but unfortunately I'm too far away. Traveling is almost out of the question for me. :-( However, I would be interested in who he would recommend as a top-notch spine surgeon in my area. The neurosurgeon I've been seeing is with Boulder Neurosurgical Associates. One of my sons lives near Boulder in Thornton CO, so it seemed best for me to have the spine surgery done near his home, as I live alone in CS. My other son lives in PA.

I've had lumbar epidural steroid injections for years, now. In June, 2011, my pain specialist had difficulty getting the injection in. Oct 2011 went back again--he said my epidural space is blocked so I can no longer have the steroid injections (which were what was keeping me going). My PCP had me see another pain doc for 2nd opinion--he said I need a laminectomy (I've been told in the past, even at Mayo Clinic, that due to my severely degenerated spine plus scoliosis that laminectomy was totally contraindicated). Next my PCP sent me to a neurosurgeon, who recommended implanting an X-Stop device. Subsequently my PCP sent me for a 2nd neurosurgeon opinion--this one took a lot of time to consider my case, studied my MRIs, Xrays, at length, etc. He said it's a very difficult case; for several days continued to study my spine films and then called a case consult with his 4 partners, and after much discussion they all agreed with him that I should have spinal fusion of just the 3 worst lumbar levels, as that is where the most severe nerve compression is--both central and foraminal. He didn't want to do more than absolutely necessary because of my age and co-morbidities, but wanted to do what he could to relieve my pain, and enable me to stand and walk enough again to remain independent in my home.

Folks on this Board encouraged me also to get an orthopedic surgeon's opinion, so I saw one at Colorado University Spine center in Denver. Without even considering all aspects of my situation, he recommended fusion of the entire lumbar spine! He is a professor at CU.

Anyway, I was scheduled for the fusion surgery May 2, 2012, and the Boulder surgeon ordered CT scan of abdomen/pelvis for surgical mapping (he was going to do the anterior spine via a minimally invasive procedure); CT found the bladder tumor incidentally. I also had a knee MRI the same day of the CT and it showed bone on bone. The neurosurgeon told me that obviously we'd have to postpone the surgery till the bladder issue was settled, and also said I'd need to get the knee working better before spine surgery as I'd have to do a lot of walking post-op for the spine to heal successfully.

Saw a knee ortho surgeon recommended by my PCP, who said he is "wise" and had taken a 1 year sabbatical not too long ago to study complicated knee procedures in Europe. Knee surgeon said to get the bladder taken care of first, and then return and we'd discuss TKR, since over the years I've already had several courses of various injections--Synvisc, Hyalgan, Eufflexia, steroids, etc. plus had arthroscopic surgery for torn mensicus in 2005--"you've already done the easy things."

I was convinced (foolishly) that the bladder "lesion" was nothing, as I had no hematuria or other symptoms, so wasn't very concerned. But when I had the cystoscopy 4/23, behold there was a large tumor. TURBT followed (5/11) with no complications, but path report of high grade stage 1.

My urologist felt the safest route for my treatment would be Mitomycin bladder instillations, once a week for 6 weeks--said IV chemo or BCG would make me too sick (I also have renal insufficiency). Had the 2nd biopsy and the first MMC on June 26, and got along fine--just a little aching and tiredness for about 24 hours. Path report is pending. Uro did say that this is an aggressive cancer and I'd need ongoing close surveillance the rest of my life. My son asked him if he thought I would eventually need an RC--he replied, "I hope not." But advised me to get an appt. with the knee surgeon and get the TKR scheduled for 2 weeks after my last chemo (July 31)--"we need to get you walking better". Of course, knee doc's first available appt is July 23 (on vacation 2 weeks in July), and scheduler said his surgery schedule is full till some time in Sept.

So that is where I am now. Neuro says can't do the spine till knee is taken care of. And you suggest the spine should be done before the knee! :-) Ah, me. It's complicated having 3 things hit all at once. Looks like my body is showing signs of wear and tear, but in spite of everything I don't feel old.

I have an appt July 9 to discuss all 3 issues with my PCP, who has known me for many years and is my hero. He takes care of me as though I were his mother. (He also was my husband's PCP.) I would have seen him sooner, but his office and home are both in the evacuated fire area. I trust him implicitly and will follow his advice. He's a very conscientious Dr., and also very conservative about surgery--always wants 2 or even 3 opinions before deciding. But he knows I'm in severe pain and losing independence due to the difficulty I have walking, from both the spine and knee problems--has recently prescribed some morphine for me to take when pain gets intolerable. I'm averse to taking narcotics, but right now there's no other recourse.

This has become such a long and involved missive I'm afraid you will regret "friending" me. I do deeply appreciate your concern and advice and will be interested in your take on all this. You've been down a long difficult pathway yourself, so what you have to say is definitely worth listening to! I hope you will continue to do well.

Thank you again,
Paula





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