Synovectomy Follow-Up Appointment

On to more serious matters. I had my follow-up appointment yesterday morning with Dr. Dye. It was another rainy day as my Mom drove me back to the city in the pouring rain. I was a little sad to be leaving Lafayette, but knew I needed to move on to my next stage of recovery from surgery. I wanted to hear what Dr. Dye had to say and whether my knee was healing appropriately or not. I also wanted to get back to my apartment to rest more and catch up on my TiVo'd shows. Hey, a girl has to stay up-to-date on Lost and The City, you know? ; )

We arrived at Dr. Dye's office around 10:00 AM. Dr. Dye's assistant Lesley brought me into the exam room, took out my stitches and checked the temperature of my knees. Huh? This was the first time anyone had done this before! The "temperature" of my knees? Lesley pointed a laser at each knee and aimed the red dot right on top of the patella. My left knee temperature was around 89 degrees and my left knee was 81 degrees. Interesting. This seemed to make sense to me as my left knee was the one healing and probably requiring more energy than the right one. Lesley confirmed this was normal. Then Dr. Dye came in and took a look at my knee. Very quickly he repeated some of what he told me in the hospital. He said he found the problematic synovitis under my kneecap and removed it. He said the synovitis (inflammation of synovial tissue causing pain) had attached itself to the underside of my patella. I think this sounds a lot more creepy than it really is and made me wonder how common this is and how misdiagnosed this origin of knee pain can be. I'm sure in most people, if they take the time to rest, the inflammation dissipates and even goes away. Dr. Dye repeated, yet again, that this was not the case for me and it needed to be fixed surgically. I asked him about my silly white stockings and he said for safe measure to leave them on until the weekend. O... K... 

I was given a referral to physical therapy and Dr. Dye said the next 2-3 months of my recovery is critical. I must not do more than what is prescribed by my physical therapist. I should also try not to get up and down as much as I usually do from my desk at work. He said to have someone "get the files for me" whenever possible. Anything that causes any pain in my knee should be stopped immediately. I need to stay within that "envelope of function" Dr. Dye always mentions. The PT referral said I should go to 2-3 times a week. What? I thought this was a lot, but I figured, alright, this is what he requires. I'll do my best to follow his program.

After my appointment, my Mom took me to Trader Joe's for some milk and needed groceries. We hauled everything (my suitcase, flowers, and food with my Mom doing most of the work) into my apartment and soon after she was on her way back to Lafayette. I stretched out on my couch and turned on the TV. It continued to be a rainy afternoon which, again, made it easy to be cozy indoors. I soon realized how hard it is to stay in one place in your own apartment. Each time I sat down I thought, "I need this, I need that." It took me a while to get set up where I could reach what I needed and not get up constantly. I iced my knee as much as possible and finally got online to answer personal emails and start to update my blog. I love my laptop! It makes it so easy to keep my leg propped up and type away. My knee felt pretty achy as I hobbled around on my crutches. I just kept telling myself, take it easy. I tried to do the same as when I was at my parents. Rest, read, watch TV, keep that leg on a pillow and ice. The main difference was that I had to get up and cook for myself. Even though my kitchen is only a few feet away, it's amazing how much effort it took to grab my favorite soy crisps or cut up an apple! Don't worry, I didn't starve. I've never been the type to go without! 

I was officially in recovery stage 2. 

Good Correspondence with Dr. Dye - II

After my first correspondence with Dr. Dye, I still had questions. Here is my second email:

Dr. Dye,

1) You mention "multi factorial" and that you are addressing the synovitis component of my knee pain. What are the other factors do you feel have lent to my pain? I imagine the synovitis is a result of some other factor such as patellofemoral syndrome. Is this correct? My main concern is that once I am through the synovectomy and slowly on my way to recovery, what can I do to keep this from happening all over again? If I don't know what exactly caused this problem to begin with, what can I do differently in the future?

4) New question. What percentage of your patients are athletes compared to patients with degenerative issues due to age or poor mechanics? Do you see many patients similar to myself? If so, how many of them experience a full recovery?

Thank you for your quick response to my email. I appreciate you being open to answering my questions.

Alexandra

Dr. Dye's response:

We often don't know all the factors that contribute to kneecap pain, but excessive loading is common to all such knees. The most important thing following surgery is prevent excessive forces out of the envelope of load acceptance for an extended period of time. It takes a year to a year and a half to maximally heal a knee, typically. It also depends on the 3rd leg of the stool (Dr Dye says recovery is a three-legged stool, 1) surgery, 2) taking care of myself after surgery and 3) --the biology of your knee., including the extent of the pathology discovered and the effectiveness of your healing properties as encoded in your DNA. We won't know until we "cross that bridge" Most people 85- 90% do well.

4) about 50% and yes most improve substantially as a function of their unique biological circumstances.

Best wishes, Dr. Dye

I am impressed with Dr. Dye's response to my questions. Most doctors take quite some time to get back to you and when they do, the answers are even more vague than the ones I received from Dr. Dye. Still, he did answer the best way he could as a doctor and did not make any promises.

Good Correspondence with Dr. Dye - I

So, I've been second-guessing myself as I'm now 5 weeks away from my second knee scope. *Gulp* Dr. Dye's assistant gave me his email address before Christmas and was basically staring at it since thinking about the questions I want to ask him. It's taken me weeks to finally write. I'm happy to say I had some quick, efficient email correspondences a few days ago.

Here is my first email to Dr. Dye:

Dear Dr. Dye,

I have scheduled my left knee Synovectomy for Feb. 11, 2009, a little over a month from now. I have some questions prior to my surgery.

1) Now that I set the date of my surgery, I'm suddenly second-guessing myself. I asked many questions during our last follow-up appointment back in October, but since a few months have passed I need to ask again. I have been suffering from my left knee pain for almost 3 years and this will be my second attempt at arthroscopic surgery. The last one did not help although did not make the pain worse. Based on how long I have been sidelined from this overuse injury, will it ever go away on it's own without surgery? I'm sorry I have to ask. I remember you mentioning if the inflammation is not removed, it will eventually start breaking down cartilage in my knee. That sounds like reason enough to get in there to me, but I just want to make sure I have all the information. I do not take any kind of surgery lightly.

2) I am taking 10 days off work after my scope, as you recommend. That said, I travel every few weeks for work. Is there a certain amount of time you advise that I should not get on an airplane? Little leg room and changing air pressure can cause some stiffness in my knee once I have arrived at my destination. I wouldn't want this to hinder my recovery, but I do need to plan ahead in case a colleague will need to help cover some of my travel for a short time.

3) Will I receive additional information on the post-surgery recovery plan before my scope? I have your instructions in icing and rest, but I'm curious about physical therapy and how quickly that will need to ensue. I had a hard time setting up my PT appointments last time around (had to wait awhile before I could start), so I wonder if I should set up my initial appointments now. Please let me know if there are any specific PT's you prefer I see.

Thank you for your time.

Best,
Alexandra Bottomley

Dr. Dye's answer:

Alexandra,

1) It's doubtful this will get better on its' own with the symptoms lasting this long. The source of your pain is no doubt, multi factorial -- the synovitis component is one which can be safely addressed with gentle surgery like we are planning. The idea is to clear out a roadblock that is delaying your knees' ability to restore homeostasis - heal itself.

2) I would recommend not traveling by plane for 4-6 weeks.

3) You could go ahead and make an initial Post Operative physical therapy appt with the the PT dept at this campus (who know well my philosophy) on the Wed following your surgery (Feb 18th) call 600 ----.

If you have any more questions , please re-contact me.

Dr. Dye

What is...

... Synovitis?

Synovitis in the most common case of pain and swelling in the knee. The synovial cells line the inside of the knee joint and make the lubrication fluid (synovial fluid) for the knee - which functions as a living biologic transmission. The synovium is the thin tissue that is made up of these synovial cell. This tissue is at a very high population just behind the patella (knee cap) and happens to be full of sensory nerves. This tissue is easily pinched with activities that load the patellofemoral joint such as climbing up or down stairs, hills, or incline, and with getting in and out of a chair, squatting or kneeling. This is just like biting the inside of one's cheek. It can cause sharp (and dull) pain and can persist because the previously thin tissue swells and more cells are replicated leading to a situation of increased vulnerability of these newly swollen tissues to re-impingement along with the symptoms of continued pain and swelling.


a Synovectomy?

The synovectomy procedure is designed to carefully remove the abnormally swollen and inflamed tissue from the inside of the knee joint. When this is done, it leaves a "raw" surface inside the knee that must re-populate with new cells that will hopefully be less painful and eventually allow greater knee function (i.e. an expansion of the Envelope of Function).