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Bilateral knee surgery gone bad!

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Bilateral knee surgery gone bad!

Rita Ferraro, ND April 9, 2021 at 5:02 pm

4 Replies

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  • #29568
    Rita Ferraro, ND
    Member
    SSRP Certified

    This is a a new patient. She is a 66 yr old woman who adopted a baby from China later on in life. Five years later her husband died of a heart attack on the side of a highway while Mom and daughter watched until the ambulance came. She was now a single older parent with a young child. She had bilateral knee replacement on July 2018 because she believed if the 2 knees were done at the same time she would be available for her young daughter sooner. She regrets her decision.

    When I looked at her knees for the first time I thought Dr Frankenstein operated on her. She had thick red, inflamed scars that were very long. It was impressive. I thought her surgery was 2 months ago.

    Patient was hobbling around in pain. Her orthopedic surgeon said everything was fine. She just needed more time to heal, but what I saw wasn’t normal. She reports no other conditions present, only that she was infertile; however I will be getting her CBC in a few days along with hormonal testing, thyroid, and inflammatory markers, Vitamin D , B12, and magnesium levels. I did an LED treatment on her and gave her anti-inflammatory supplements. I started her on a nutrition program as well as replacing environmental toxins in her house…cleaning products, laundry detergent, gave her a gauss meter to check her home for emf, etc. She sleeps 6-7 hours a night. She called me last week and told me she went on a short hike with her daughter with decreased pain probably due to the LED treatment but it won’t last.

    Before I go further with her treatment what do you suggest for this patient? Where do peptides have a place? She can’t do the HIIT exercises at this time. Is there another way to do HIIT without using her knees? She is walking now.

    #29569
    Kristelle Reyes
    Member
    SSRP Staff

    Hello Dr. @saveyourlife1956gmail-com!

    Here’s a video reply from Dr. Seeds’ SSRP Office Hours 4/13/21 at 00:33, please watch below:

    Thank you! 🙂

    #29570
    Rita Ferraro, ND
    Member
    SSRP Certified

    Thank you Dr Seed’s for taking so much time with my patient case. Keep you posted. This patient is very motivated and has a very special relationship with me. I know she’ll be in it for the long term. I have learned so much.

    #29571
    Kristelle Reyes
    Member
    SSRP Staff

    Claim your CME here: https://earnc.me/5WTrRb

    #29572
    Giovanni Silva
    Member
    SSRP Certified

    What I typically see with “failed” orthopedic surgical procedures is the excessive scarification (tissue destruction) in the involved surgical tissue/site. The up-regulation of excessive scar-tissue formation (within tendon(s), muscle(s), ligament(s)) can be due to increased (too much) mechanical stress and/or,  immune/inflammatory dysregulation during the healing or rehab process. This WILL cause aberrant joint mobility which WILL then lead to increased inflammation……THIS CYCLE WILL PERPETUATE until it is managed properly.

    To touch on the “mechanical stress” subject, I will usually tell my patients to stop ALL current rehab protocols. 90%+ of the time, the inflammatory cascade will diminish.

    Now, the immune/inflammatory dysregulation that occurs is the increase in neutrophilic infiltration into inflamed tissue WITHOUT proper macrophage phagocytosis of this neutrophilic infiltration. As you know, neutrophils have a half-life of 6-10 hrs. before they degranulate and cause more tissue destruction within the inflamed tissue/site if macrophages cannot phagotocize them and transfer them thru the lymph system.

    NFkappaB is an activator of inflammation….STAT3 is an activator of autoimmunity.  NFkappaB is a central chemical actor in inflammation and it drives the activation of STAT3 in tissue destruction (excess scarification formation). NFkappaB drives gene expression TNFalpha and IL-6 which further drives neutrophil influx into tissue. Macrophages (as they phagtosize neutrophils for clearance) will secrete TGFbeta, IL-10, PGE2 (anti-inflammatory).

    Tx:

    • NSAIDS disrupt PGE2and are resolution-toxic (resolution phase of inflammation)
    • Pro-resolving lipid mediators (EPA-DHA) inhibit increased/excessive neutrophilic infiltration.
    • Curcumin, resveratrol inhibit NFkappaB, thus down-regulating TNFalpha/IL-1beta
    • Glutathione /lipoic acid to reduce oxidative stress
    • “Chemokines-chemotacticcytokines that mediate inflammation” N Engl J Med, 1998 Feb12
    • “Chronic inflammation; a failure of resolution” Int J Exp Pathol 2007 Apr
    • “Profiling in resolving inflammatory exudates identifies novel anti-inflammatory and pro-resolving mediators and signals for termination” J Inter Med 2010

     

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