... 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).
Thursday, October 9, 2008
Tuesday, October 7, 2008
It's Decision Time Again
I'm still processing my morning follow-up appointment with Dr. Dye. Again, I tried hard to not set any expectations. My guess was that he would have some additional treatments to attempt before considering anything more invasive. Maybe a cortisone shot or draining the fluid in my knee? I wasn't sure if these were options, but I figured something along these lines could come up. Dr. Dye walked into the exam room and asked me, "So, how is your knee?" I said, "The same as usual." He sighed and said, "Well, it was worth a try." He immediately launched into what he would need to do next to help me. Arthroscopic surgery for a synovectomy. Really? Wow. It was a little surreal to listen to him tell me about the surgery. I didn't think I would be hearing this so soon, but at the same time, Dr. Dye doesn't seem to one to waste a moment. Here are several things I have been thinking about today since my appointment:
1) I feel a little like I've wasted the last 14 months. It looks like I chose the wrong doctor over a year ago. Not that I didn't think Dr. Anderson was the best for me at the time, I had already seen 3 other doctors previous to her! She came highly recommended and seemed to do the most for me, even cared for me and my well being more than anyone else. Two of the other doctors I saw were so rude and condescending. Still, I also realize (as many people have told me) sometimes it takes a long time to find the doctor that can really solve your problem. It's a long process and hopefully one doctor does not make the problem worse before you find another that can really help. Dr. Anderson didn't make my knee worse, it just didn't get better.
2) Dr. Dye said after the synovectomy, I need to expect a year and half before I'm back to regular activity and exercise. Dr. Anderson and my past physical therapists said I could be back to running 3 to 4 months after the scope, which didn't turn out to be true in any way. If anything, they probably pushed me to fast into exercises that caused too much load on my knee. Dr. Dye said he requires a much slower healing time and does not allow his patients to jump back into their old activities too soon.
3) I'm not sure if I even have a choice here. As I have recently learned, Synovitis is not a benign condition. The inflammation in my knee does not seem as if it will dissipate on it's own. I understand that over time if I leave the inflammation where it is, it will eventually start to break down the cartilage in my knee. That is bad. As I'm sitting here writing this post, I can feel the familiar burning sensation inside my knee. It would be more healthy and much more comfortable for that to finally be gone.
Those things said, I haven't made a final decision and am planning to let this information settle in for a few days. I'm going to call Dr. Dye's assistant who should be able to tell me how much this surgery will cost. Not that money should be a part of my decision (my health is most important), but I need to know what I may need to plan to save over the next few months if I choose the surgery route again. Unfortunately, Dr. Dye is an out-of-network doctor for me, but the hospital fees will be covered by my insurance. Dr. Dye said he requires his patients to stay one night in the hospital after the scope. That way he can monitor the first critical 24 hours of healing much more carefully than if he sent a patient home. Interesting... I've only been in the hospital for outpatient procedures, usually less than 12 hours. Hospital food, anyone?
1) I feel a little like I've wasted the last 14 months. It looks like I chose the wrong doctor over a year ago. Not that I didn't think Dr. Anderson was the best for me at the time, I had already seen 3 other doctors previous to her! She came highly recommended and seemed to do the most for me, even cared for me and my well being more than anyone else. Two of the other doctors I saw were so rude and condescending. Still, I also realize (as many people have told me) sometimes it takes a long time to find the doctor that can really solve your problem. It's a long process and hopefully one doctor does not make the problem worse before you find another that can really help. Dr. Anderson didn't make my knee worse, it just didn't get better.
2) Dr. Dye said after the synovectomy, I need to expect a year and half before I'm back to regular activity and exercise. Dr. Anderson and my past physical therapists said I could be back to running 3 to 4 months after the scope, which didn't turn out to be true in any way. If anything, they probably pushed me to fast into exercises that caused too much load on my knee. Dr. Dye said he requires a much slower healing time and does not allow his patients to jump back into their old activities too soon.
3) I'm not sure if I even have a choice here. As I have recently learned, Synovitis is not a benign condition. The inflammation in my knee does not seem as if it will dissipate on it's own. I understand that over time if I leave the inflammation where it is, it will eventually start to break down the cartilage in my knee. That is bad. As I'm sitting here writing this post, I can feel the familiar burning sensation inside my knee. It would be more healthy and much more comfortable for that to finally be gone.
Those things said, I haven't made a final decision and am planning to let this information settle in for a few days. I'm going to call Dr. Dye's assistant who should be able to tell me how much this surgery will cost. Not that money should be a part of my decision (my health is most important), but I need to know what I may need to plan to save over the next few months if I choose the surgery route again. Unfortunately, Dr. Dye is an out-of-network doctor for me, but the hospital fees will be covered by my insurance. Dr. Dye said he requires his patients to stay one night in the hospital after the scope. That way he can monitor the first critical 24 hours of healing much more carefully than if he sent a patient home. Interesting... I've only been in the hospital for outpatient procedures, usually less than 12 hours. Hospital food, anyone?
Wednesday, September 24, 2008
Tuesday, September 16, 2008
A Classic Case
I was neither nervous or excited about my follow-up appointment to see Dr. Dye this morning. Honestly, I felt a little numb to the whole thing. Really, what new information about my knee could he possibly tell me? It seemed as though I had heard it all. Well, maybe not. I walked through the door of his medical office a little early expecting to wait. Instead, Dr. Dye's assistant asked me to come right in to an exam room and a few minutes later, Dr. Dye walked through the door. He got right down to it. I've realized in my two short appointments with him that he doesn't waste any time. He talks quickly, but not so quickly that you don't understand what he is explaining. First, he told me the good news. He popped my X-ray and my bone scan films up on the light box and told me my joints look great (good space between the bones, no breakdown of cartilage) and the best part is that the bone scan was clear of any signs of arthritis. Yeah! I wasn't particularly worried about this until Dr. Dye told me 85% of the patients that come to see him have an onset of arthritis that needs to be addressed immediately. I was quite happy to hear I'm one of the small 15% without that issue.
Next, Dr. Dye moved on to the MRI films. In a very confident, matter-of-fact manner he told me, "You have a classic case of Synovitis" and pointed to the many areas on the film showing excess fluid build-up. He said me Synovitis is common and is basically an inflammation of the synovial lining in the knee. Once aggravated, it is very hard to calm down. This is a short online definition I found online:
Synovitis occurs when the synovium, which lines and lubricates the knee joint, becomes inflamed. The condition can be caused by rheumatoid arthritis or injury/trauma, but sometimes the cause is unknown. The inflammation is caused by fluid collection in response to the injury, which is one of the body's protection mechanisms.
Here is a link to additional information, if you are interested:
http://www.knee1.com/care/condition20.cfm/108
After telling me about Synovitis, Dr. Dye told me his next treatment steps. He prescribed a strong anti-inflammatory drug he called his "work horse." Then he said to make sure to ice my knee twice a day for 20 minutes. Finally, he said I should do my best to not do the things I know flare up my knee, such as stairs or squatting. He suggested maybe I could do some swimming or a little light cycling. I'm the only person that knows what is in my "envelope of function" so, it's really up to me. Sounds good, right? Ugh... it took a lot of strength on my part to not burst out and say, "But doctor, I've done all this!" I mentioned that briefly, but kept a majority of the emotion to myself. I felt better when he said to set-up another follow-up appointment in 3-4 weeks so he's not putting me on this regimen for months on end.
On my way to work, I thought more about this initial treatment and it started to make more sense. I am a new patient to Dr. Dye. Even though I've told him my history, he doesn't know me from Adam. If he did not ask me to follow his steps from the beginning (that I am sure he has a great deal of research behind) he would not be doing his do-diligence as a good doctor. I respect this and I will follow his instructions. Besides, maybe the anti-inflammatory he has prescribed will be my magic pill? You never know.
By the way, I didn't ask Dr. Dye anything along the lines of, "What if this doesn't help?" I'll cross that bridge when we come to it next month. For now, I'll just focus on the task at hand. I'll be keeping to a few short lunch walks (no hills) during the week and and maybe an easy swim on the weekends. Fairly light activity that shouldn't bother my knee. Elevators and escalators are my friends. : )
Next, Dr. Dye moved on to the MRI films. In a very confident, matter-of-fact manner he told me, "You have a classic case of Synovitis" and pointed to the many areas on the film showing excess fluid build-up. He said me Synovitis is common and is basically an inflammation of the synovial lining in the knee. Once aggravated, it is very hard to calm down. This is a short online definition I found online:
Synovitis occurs when the synovium, which lines and lubricates the knee joint, becomes inflamed. The condition can be caused by rheumatoid arthritis or injury/trauma, but sometimes the cause is unknown. The inflammation is caused by fluid collection in response to the injury, which is one of the body's protection mechanisms.
Here is a link to additional information, if you are interested:
http://www.knee1.com/care/condition20.cfm/108
After telling me about Synovitis, Dr. Dye told me his next treatment steps. He prescribed a strong anti-inflammatory drug he called his "work horse." Then he said to make sure to ice my knee twice a day for 20 minutes. Finally, he said I should do my best to not do the things I know flare up my knee, such as stairs or squatting. He suggested maybe I could do some swimming or a little light cycling. I'm the only person that knows what is in my "envelope of function" so, it's really up to me. Sounds good, right? Ugh... it took a lot of strength on my part to not burst out and say, "But doctor, I've done all this!" I mentioned that briefly, but kept a majority of the emotion to myself. I felt better when he said to set-up another follow-up appointment in 3-4 weeks so he's not putting me on this regimen for months on end.
On my way to work, I thought more about this initial treatment and it started to make more sense. I am a new patient to Dr. Dye. Even though I've told him my history, he doesn't know me from Adam. If he did not ask me to follow his steps from the beginning (that I am sure he has a great deal of research behind) he would not be doing his do-diligence as a good doctor. I respect this and I will follow his instructions. Besides, maybe the anti-inflammatory he has prescribed will be my magic pill? You never know.
By the way, I didn't ask Dr. Dye anything along the lines of, "What if this doesn't help?" I'll cross that bridge when we come to it next month. For now, I'll just focus on the task at hand. I'll be keeping to a few short lunch walks (no hills) during the week and and maybe an easy swim on the weekends. Fairly light activity that shouldn't bother my knee. Elevators and escalators are my friends. : )
Thursday, September 4, 2008
Made My Day
A freelance graphic designer at work said something really nice to me today. As she passed me in the hallway she said, "Do you work out?" I paused for a second then replied, "Wow, thank you for saying that." Inside, I just wanted to hug her! I told her I haven't been able to exercise much since my knee injury. She mentioned she figured I must do something athletic. I told her I used to run marathons and do triathlons. She just nodded and said I have that type of body, then she walked away. Little does she know how much her comment meant to me... it's been so long since I've had a regular workout routine! I guess I must maintain some muscle tone because otherwise she wouldn't have asked me the question. She just made my day!
This reminds me how I should compliment people more often. Doesn't it feel good when someone says something nice to you? Let's all make an extra effort, OK?
This reminds me how I should compliment people more often. Doesn't it feel good when someone says something nice to you? Let's all make an extra effort, OK?
Wednesday, September 3, 2008
Monday, September 1, 2008
A Day in Napa Valley
Yesterday, I spent the day with friends in the Napa Valley. It was a beautiful day and, as usual, the vineyards were picturesque. After church, the four of us hopped in the car and drove the one hour, fifteen minute road trip up to Napa. We ate a picnic lunch at V. Satturi winery, then tasted some wines at Plumpjack winery. Our next stop was olive oil tasting. Yes, EVOO (if you don't watch Rachel Ray, this means Extra Virgin Olive Oil). It was wonderful, I loved it! We went to an olive oil mill called Round Pond. A woman named Megan, gave us a tour of an olive orchard (mixed in and around the Round Pond vineyards) and then the olive mill itself. Round Pond takes the olives from picking, to milling, and into the bottles in 3 hours! It's amazing. Megan hosted a lovely sit-down tasting with their Italian and Spanish varietal EVOO's and lemon and blood orange fused EVOO's, along with red wine vinegars and fruit syrups they also produce. 
We tasted the many oils and vinegars with fresh cut greens, French bread, tomatoes, cheese and strawberries. It was SO yummy. I decided to purchase the Spanish varietal EVOO and a small bottle of the Merlot red wine vinegar. Below is the link to the Round Pond site. I thoroughly recommend you make a reservation for a tour and tasting the next time you travel to the Napa Valley, or simply buy online. It's worth it!http://www.roundpond.com/
I'm on the left with my friends Peter, Carol, and Sarah.
I'm not sure why this photo ended up so blurry! I will replace it if Carol or Sarah send me a better image, as they took photos with their cameras as well. We ended the day at Auberge du Soleil, a beautiful inn with amazing views of the valley. We sat out on this balcony and enjoyed a glass of wine before it was time to return to the city. Isn't the Bay Area great?
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