Debridement, Biocartilage + BMAC at HSS

[BLT]

Progress is wonderful 

[Kerri]

Further update:   I'm now walking about 1/2 mile on 1 crutch, plus 20 minutes on the bike (easy), plus some swimming.    Very happy!

[cshires]

Woohoo!

[wallywest]

Thanks Justin.

Drakos told me that for about the last a year and a half (more than 60 procedures before mine) he had stopped using micro fracture.   He does "scrape down to healthy, bleeding bone" to create vascularity for the new cells.   He believes this is the best treatment, regardless of size and position.

I saw probably 6-7 doctors before deciding what to do.   Even at HSS, other doctors are doing MF.   Kennedy does it.  O'Malley told me that he would do the same thing as Drakos.  (I have some other posts on here outlining what the various doctors recommended.)

I went with Drakos in the end because his approach seemed proportional for the extent of my problem -- which had reached a point that I needed to do something, but wasn't completely debilitating by any means.

Drakos also told me that he doesn't have 5 year evidence -- the procedure is still too new.  He said he has had great success with it, but he just can't tell me what will happen in 5 years.  That is what he articulated as his biggest concern about doing the procedure.

I was also told by Drakos that, if it didn't work or the repair failed in the future, I wouldn't be any worse off than before the procedure.

Kennedy had recommended against MF for me (he wanted to do a much more invasive procedure called OATS) because he believed in my case, due to the position of the lesion, MF would ultimately fail, and I'd be left with a bigger lesion than I started with.  (These guys are all doing their best to read MRIs, and I don't think its a perfect science.   He and Drakos and O'Malley all had different opinions about the size and exact placement of my lesion.  Drakos told me post-surgery that the one they were primarily dealing with was not on the shoulder -- which was good.  The small lateral one that was the secondary problem was on the shoulder)

Hope that's all helpful.   My biggest suggestion is, if you can take the time and can afford it, get multiple opinions from doctors until you feel really comfortable with a doctor and a procedure.

Good luck!

Kerri

Long time coming to respond, just had a lot of issues of late.  THANKS so much for this detailed explanation.  I can't tell you how much it has helped me going through a similar decision process.  Glad to see that recovery is going well and may it still continue.

Justin

[mtmatsum]

From this post, I was fortunate to find out about the more novel procedure done at HSS for OCD and decided to get surgery there.  I'm a 2 week post-op with right OCD and I was NWB for the 2 weeks and just had my cast removed.  Going to be starting NWB PT next week.  I hope to post updates on my improvements in this thread.  Special thanks to Kerri for sharing her experiences.

[Kerri]

Congrats on getting through those first 2 weeks!  What a pain keeping the foot elevated 22 hours a day!!

My update:   Tuesday night for the first time I walked about 20 steps (not consecutive steps, but steps!) with no crutch.  Had to dial back on Wednesday while things settled down.   Yesterday I probably walked 50-75 steps with no crutch.   It was achy over night, but this morning I made my breakfast with no crutches!   Its the little things...

I'm also getting PT now for the non operative side hoping that the flare up there can be addressed with conservative treatment.

[Kerri]

Update!!   I put on pants this morning from a standing position, barefoot, no crutches!   And then walked around my apartment for 10 minutes with a slight limp, no crutches.

Progress!

[jnj15]

Kerri, sounds great! I'm having trouble following your recovery though. Are you still in a boot? How long were you NWB and PWB? Is the limp just out of caution or do you have some pain?

[Kerri]

Hey Jason - I was NWB for 6 weeks, then in the boot until the end of week 14.  By the end of week 14 (I saw Dr. Drakos exactly I day before the 15th week after surgery) I was able to walk with no crutches in the boot, but not for a long time (I carried around a crutch) and not without limping.

Now I'm about 12 days into being in hiking boots or sneakers, and although I initially had to go back to 2 crutches I'm back to walking several blocks with no crutch (or around my apartment with no crutch), and then using one crutch when it gets sore.

I'm limping, I guess, out of a mix of some pain (mostly tendons I think) when I step down and some muscle weakness in the hip and calf.   I'm not sure that any of the pain is particularly OCD pain, but I really have no idea since most of the time before my surgery the pain moved around as well.  In any event, right after I stretch and begin walking for the day, it feels pretty good.

Drakos said to be patient...

[Kerri]

Hi All,

Just a belated update.   Surgery was May 26th so I'm a little over 9 months into recovery.

The good news:  all the old OCD symptoms that were detectible when i was inactive are gone - deep throbbing, and almost a vibrating feeling.  I can't really speak to the OCD symptoms that were detectible after extreme activity since I'm not back to normal activities yet.

Also on the good news front:  I can now get on a stationary bike and go hard for 30 minutes, including some standing, and then also get on the erg and row and do some standing weightlifting.

The bad news:   I have not fully recovered and walking and standing are still uncomfortable, apparently due to a lack of full range of motion.  My surgeon (Dr. Drakos) thinks its probably an impingement from scar tissue.   And while I have heard other surgeons have been more aggressive trying to address the scar tissue, Drakos wants me to wait a full year and continue with PT.  He also has me in an orthotic now (which honestly I think makes things worse overall, but I'm trying to worth with the orthotist to fiddle with it so that it works better for me).   Last, he doesn't want to do an MRI at this time since he doesn't think it will tell him anything new.

The watchword continues to be patience.  Which I'm finding in short supply but trying.   I chose Drakos because I preferred his conservative approach over the more invasive procedures that had been offered to me, so I'm staying this course for another couple of months and then will see where I'm at.   Especially because I also have an OCD in the other ankle so may need to do this whole thing over again.  Joy!

I'm also probably moving west for the next [3-6] months, and will be interested to see how the change in climate may effect me (warmer but damper).

Good luck to all!

Kerri

[Kerri]

Update, inspired by having coffee today in Seattle with Christina.

1.  We both walked to coffee! 
2.  I recently had shockwave therapy on the left (operative) side to try to help break up scar tissue.  I have still not regained full range of motion, which is generally causing aches and pains in the hip and lower back, as well as fairly regular discomfort (but not pain) in the ankle.
3.  Recent MRI of the operative side indicated the cartilage had filled in well and the bone edema is basically gone.   So the problem is the scar tissue it seems.  Drakos remains very optimistic and is encouraging me to do as much PT and stretching as possible.   If the shockwave seems to have made a difference, we'll do it again in 4-5 weeks.
4.  Right side has worsened.  More classic OCD symptoms, same as I had in the left before surgery.  So we tried a shot of monovisc to alleviate symptoms.   Not sure yet if that's doing anything. 
5.  I did get out for my first pretty strenuous use of the ankles:  a 1 1/2 hour snowshoe hike in BC, where it is anything but flat.   I was in a fair bit of discomfort the week after, but I did it.
6.  This weekend I'm planning to push the envelop by walking a 5K road race, moving apartments, and then doing another snowshoe hike the next day.  We'll see....

All in all I remain less functional than before surgery.  But I can tell the problems with the left side are completely different than before surgery.

And it was great to see Christina!

[ocdnetadmin]

Thanks for the update Kerri.

Best wishes on your continued progress and recovery.

[Kerri]

Update:   I'm now almost 15 months post surgery (left ankle).

After 2 rounds of shockwave therapy, a lot of angst and a lot of PT, my left ankle is back to almost a completely normal range of motion.  I have none of the old OCD pain; although I do occasionally have trouble with the ankle in other ways (especially when there are extreme weather changes).

That's the good news.

The bad news is that the right ankle has continued to deteriorate and I'm now considering if/when I could do another surgery.   I'm being fairly active (rowing and biking), and am not really in paid during those activities, but the last month or so have been in pretty constant discomfort just walking.

Drakos wanted me to get out of Nikes and try New Balance.  Also, he wanted me to wear my prescription orthotics regularly.   I've tried that but it doesn't seem to help (and sometimes makes it seem worse).

Stay tuned.

[ocdnetadmin]

IN my experience, the ankle braces and orthotics have done NOTHING for my ankle and like you, sometimes seem to make things worse due to how bulky and unnatural they feel

How bad are the OCDs in your right ankle? Have they actually been confirmed as OCD by an MRI?

[ColSteve]

Hi Kerri, Glad to hear that your left ankle is almost back to normal!  That is great news!  I am really sorry to hear about your right ankle – hope the surgery goes well if you go that route.  FWIW,  I have had similar experiences with orthotics – but maybe I have not taken enough time to get comfortable with them.