A second opinion is warranted after a ‘cleanse’ for knee arthritis

Dr. Keith Roach

DEAR DR. ROACH: I’m a 71-year-old male, 6-foot-1, 240 pounds, with atrial fibrillation. It didn’t affect my lifestyle. About 90 days ago I had meniscus surgery called “cleaning”. Afterwards, my orthopedic surgeon said that I should be much better, although there was significant arthritis. The operation did not bring me much relief. After examination yesterday, the doctor injected me with cortisone in the knee, explaining that it was the last alternative before a knee arthroplasty.
The surgeon explained that he had had two patients with a similar physical condition die within days of having knee replacements and he was hesitant to do one for me. I would like your opinion on what to do if cortisone does not bring me relief. —MH
ANSWER: I am intrigued by what the orthopedic surgeon did and said. You have identified two diagnoses in your knee: arthritis and meniscal disease. The “cleaning” you describe sounds like a procedure called arthroscopic debridement that was done in the 1980s and 1990s when I was a student and a resident. These procedures have largely been abandoned because they have repeatedly been shown in well-conducted trials to have no benefit over standard treatment, such as exercise and physiotherapy.
Similarly, cortisone injections were once an integral part of treatment, but again several trials have shown that they offer no improvement over the injection of a simple anesthetic, suggesting that most Patient-perceived benefits are a placebo response. Repeated cortisone injections over the years damage the knee cartilage.
In an experienced hospital, where cardiologists and surgeons work together, there is no significant increase in the risk of knee replacement surgery for someone with atrial fibrillation. Care must be taken, of course, but many patients with atrial fibrillation go through knee replacement surgery.
Based on what you say alone, I’m afraid the orthopedic surgeon is not practicing the current standard of care. He may also have allowed his own bad experience to keep him from recommending a procedure that could significantly improve your quality of life. There are two sides to every story, and maybe there are good reasons for what the surgeon did based on medical information that I don’t know, but I recommend you get a second evaluation by another surgeon.
DEAR DR. ROACH: I became lactose intolerant after back surgery last summer. Recovery was difficult only because I had lost my appetite for over two weeks. While trying to regain weight, I made smoothies but had an unpleasant digestive reaction. I’m on anything lactose free, but wish I could go back to using even small amounts of lactose-containing foods. What happened? Can I go back to having something with milk in it? I am 76 years old. — CL
ANSWER: Intolerance to foods containing lactose, primarily milk and cheese, is increasingly common as we age. Still, it’s unusual to see the sudden onset of symptoms in someone in their 60s, and I suspect it was due to the challenge to your gut from having increased amounts of lactose in your smoothies.
There are many foods available in a lactose-free version. You can try taking a lactase enzyme supplement before eating foods that contain lactose. My experience is that they work pretty well for some people and not at all for others, and too much lactose will always negate the benefits of the enzyme.
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Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can send questions to [email protected] or mail to 628 Virginia Dr., Orlando, FL 32803.

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