Saturday, January 22, 2011

Is there a role for your primary care physician in considering the options, directions and decisions you make re the hip replacement? A resounding yes!

Yesterday, I made a trip to my internist AKA,  my primary care physician.  She is bright and typical of most internists; she has the desire to solidify a strategy with  the facts in place before we make a decision.  She noted I was “stuck” in terms of being able to move forward with a plan confidently, and she was right:
·         My Chromium and Cobalt tests were missing after 6 weeks of retesting.
·        I was uncomfortable jumping from metal to another material when I have found issues with the other materials used in these hips as well.
·         I didn’t understand the evidence well enough to buy into the recommendation to replace the hip made by my surgeon.  I really needed more information to ensure that I was not jumping from the proverbial frying pan into the fire.
First, she found the toxicity tests from the lab.  While the results are not good, at least I have them.

Normal results
Less than 2 mcg/l
Less than 1.8mcg/l
My results
26 mcg/l
33.9 mcg/l

(1)   Concerns about these chemical levels in the organs (not measured by the blood tests.)
I explained to her that my primary concern was not just the blood levels of these chemicals but the measurement of the levels of these chemicals that are now likely accumulated in the organs. She seemed to think this was an appropriate concern however, she questioned whether such a test existed which would provide a deterministic answer absent doing an biopsy which she didn't seem to think was appropriate.  She did think we could review kidney and liver function.  I think that any damage that might occur with these organs involves long term issues but we’ll see what these tests turn up.  My concern is that I only have one Kidney remaining.  I am understandably concerned about  having it destroyed with carcinogens or other issues that might take years to develop.
(2)   Concerns about determining through an MRI (not a soft tissue scan) the extent of damage or lack thereof to help me make my decision.  The MARS scan which I have written about in a previous post, is a good option coupled with the correct radiology protocol for this type of problem.  Not all hospitals have experience in running the MARS hip protocols.
(3)   Concerns about choosing the correct replacement material given the issues with other materials available.
(4)   Do we have the correct procedures in place to have the extracted hip sent to the best lab for evaluation following the surgery to determine the extent or type  damage I might have sustained  caused by examining the “old” hip?
She was to get back to me once she reviewed the information and happy to share our strategy once we have it in place.  I was really greateful for the "take charge" attitude she assumed.


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