Monday, May 30, 2011

My final visit with my Ortho Surgeon Tomorrow

I finally collected all of the recommendations from the consults and will be reviewing them tomorrow with my Ortho. Surgeon (This appointment was postponed for two months due the need for written opinions from the consults.)  

My agenda:
  • Review the consults opinions (one ion expert, one ortho surgeon, one MRI, one toxicologist, one nephrologist.
    • especially interested in his opinion of the MRI results
  • Reach agreement on the next step following my investigation and his prior recommendation.
  • Review the replacement he would like to use on revision
  • Discuss whether I should have an allergy test (to the metals) prior to the revision.
  • What is the plan with explant?
  • Are there any tests I can get re measuring the systemic levels in the Kidney, spleen and lymph nodes
  • Will be handing him 3 articles:
    • Silent soft tissue pathology (mainly for his other patients)
    • Instructional review of the evidence thus far for MoM implants- I will be publishing something on this soon.  Excellent summary.
    • Out of Joint which is the summary of what did depuy know and when did they know it.
  • I will be handing him 3 abstracts:
    • Nine year Incidence of Kidney Disease in Patients who have had total hip Artroplasty- just published by Dept of Ortho Surgery at Stanford.
    • March paper on the Pragmatic clinical work up of patients with allergic disease to MoM implants by the Cleveland clinic and others.
    • Abstract on several assays that might be used to look at allergies to MoM.
  • What kind of dates are available for the surgery?
I will be asking him to phone one the ion consult for 3 reasons:
  • Are we selecting the right replacement?
  • What about the explant-will my consult take it?
  • Testing
    • Is it worth while to consider the allergy test which in fact was recommended by the toxicologist.
    • Are there any tests we can undertake for the systemic issues?

1 comment:

  1. Connie

    very impressed with your structured approach - we can all learn a lot from it.