Back to the ortho?

[severine]

I don't feel that my ortho did a disservice by waiting. He did seem genuinely convinced that I would have no problems healing in time to ski at MRG next week. He was a bit surprised to see me back in the office today. I appreciate that he didn't jump right to the MRI as they are expensive and I can't afford to be paying for anything that isn't absolutely necessary.

I have confidence in him. Here's his bio from their website:

Sports Medicine / Arthroscopic Surgery

Dr. Brezenoff graduated from Union College and the University of Medicine and Dentistry of New Jersey. He then completed an internship at Albert Einstein Medical Center in Philadelphia, PA and a residency in orthopedic surgery at Montefiore Medical Center in Bronx, NY. In 2000, he completed a fellowship in Sports Medicine and Shoulder and Elbow surgery affiliated with Georgetown University, where he treated professional and Division I athletes. Dr. Brezenoff is certified by the American Board of Orthopedic Surgery, and is a member of the American Academy of Orthopedic Surgery and the American Orthopedic Society for Sports Medicine.

Dr. Brezenoff practiced in Bethlehem, PA for four years where he had an active sports medicine practice serving as the team physician for several area high schools, as well as DeSales University. He has vast experience in non-operative rehabilitation of sports related injuries as well as advanced minimally invasive arthroscopic surgery of the shoulder, knee, elbow, and ankle. He also performs ligament reconstructions, joint preserving surgery, replacements of the knee and shoulder, and the treatment of fractures.

 

[Dr Skimeister]

Here's wishes for fast healing for both of you.

 

[Paul]

Wow, hate to hear about all these knee injuries, looks like I was a year early to join the club.
Wa, What kind of brace? If he thought there was a real ACL issue, you likely would be in an immobilizer.
Sev, No disservice, I agree. These things can be tricky to diagnose. Best wishes to you both.

 

[wa-loaf]

Wa, What kind of brace? If he thought there was a real ACL issue, you likely would be in an immobilizer.

I don't think she thinks there's really anything major. In the x-ray it looks like I chipped a small chunk off of my kneecap (although that could also just be the way it is), but I did crash into the guy knee first and then twisted around him. So it's both an impact and forward twisting injury. The MRI is to check out the kneecap and to rule out an ACL tear. In checking out my knee she felt there was a little more movement than normal, but I didn't feel any pain from what she did, so any damage is likely minor.

Drawing the fluid off of my knee really helped my range of motion. I was having a tough time bending the knee too far. That was the most painful part of the day.

The brace I got is just a neoprene pull-on with plastic rods on the side and hinges.

My follow up is Thursday afternoon. So I'll know more then.

 

[severine]

I'm having problems with swelling (fluid) affecting ROM now, too. ROM wasn't bad up until recently. Caring for and picking up after 2 small children all day isn't helping.

Have to call the office this morning. I may not be able to get an MRI... need to see what they say.

 

[wa-loaf]

I may not be able to get an MRI... need to see what they say.

Because your insurance won't approve it?

 

[severine]

Because I have an IUD. On WebMD that's listed under things that may prevent you from getting an MRI.

 

[wa-loaf]

Because I have an IUD. On WebMD that's listed under things that may prevent you from getting an MRI.

Oh right, I saw that on the check list. Eyelid springs are also not good for MRIs! Something I didn't know existed until I saw it.

Are there any other options?

 

[severine]

I think the only alternative is arthroscopic if x-ray wasn't decisive and they can't do an MRI. Not sure, though.

They're supposed to call me today anyway so I'll wait for the call and see. Some sites say it's a problem, others say it is not. I think it has to do with how much they crank up the magnet, but I'm not entirely sure having never done this before.

Never heard of eyelid springs before either! Wow!

 

[drjeff]

I think the only alternative is arthroscopic if x-ray wasn't decisive and they can't do an MRI. Not sure, though.

They're supposed to call me today anyway so I'll wait for the call and see. Some sites say it's a problem, others say it is not. I think it has to do with how much they crank up the magnet, but I'm not entirely sure having never done this before.

Never heard of eyelid springs before either! Wow!

Unless you have really, really, really short legs, for a knee MRI, or for any "small body part" MRI for that matter, the radiation exposure field is quite small and limited. I send folks a few times a year for an MRI of their sinuses, and the per the radiologist at the scanning center I send my patients to, the radiation exposure field for the sinus scan is basically from the patients pupils to roughly their lower jaw gum line. Outside of that with images taken ona modern MRI machine the radiation exposure is essentially nil.

Sounds like in your case, its good 'ol fashioned insurance company policies where personal health is often second fiddle to corporate profits

A typical knee MRI scan: (note the radiation exposure field extends maybe an inch above and an inch below the image)

Why though sometimes metal and MRI's can be a problem if the metal is in the image fiels, is that the radition beam from the MRI "hits" a metallic object, you get on the image what is called "scatter" which is the star like "eplosion looking" streaks in the image belowNote the picture below is a CT scan, not an MRI, but I couldn't find any good "scatter" MRI pics online, you get the same results from both imagining systems though with respect to metal)

You can see how something like that *might* make it tough for the radiologist to properly interpret the image

 

[severine]

I'm actually surprised ultrasound isn't used. It shows tissues and bone. Cheaper and can be done in office.

Like I said, I'm no expert here. Just repeating what I read. Could be a non-issue (and I'm hoping that it is). I'd rather be informed than have the appt, struggle for child care (possibly even a ride because I'm claustrophobic and may need to be sedated), and then find out that they can't do it because of the IUD.

drjeff - Is it true that amalgam fillings can heat up during MRI? That's another thing I read. I believe I still have 2 amalgam fillings.

BTW, I'm typing this while sitting in my old pair of ski boots (new pair will be picked up this afternoon). It's almost as bad as summer jonesing....

 

[wa-loaf]

It's not the radiation that's the problem it's the magnet. Anything metal that's not tied down (or part of your body) can get yanked out of position: http://www.webmd.com/news/20010801/fatal-mri-accident-is-first-of-its-kind

 

[severine]

Exactly. Anyone who was watching NCIS last night could see that magnetic metal in the body issue in action.

Besides, if it were radiation that were the problem, I'd already be screwed with all the x-rays I've had done since getting the IUD.

Still waiting on the call....

 

[Paul]

No need for sedation, an MRI on your knee won't involve getting your head into the tube. You'll only go in, at most, waist to mid-chest deep. The tough part is laying still for 20 min with that damned racket. SRSLY, those things are loud! They'll give you ear-plugs.

Also, I have about a half-dozen metal-amalgam fillings along with a metal crown. No problems, I believe they are non-ferrous, so aren't affected by the magnet. They did have to give me full head X-rays first, however, because I had a previous eye-injury where I had a piece of steel embedded in my cornea for about 2.5 months. Needed to make sure there wasn't any left. :-o

 

[drjeff]

I'm actually surprised ultrasound isn't used. It shows tissues and bone. Cheaper and can be done in office.

Like I said, I'm no expert here. Just repeating what I read. Could be a non-issue (and I'm hoping that it is). I'd rather be informed than have the appt, struggle for child care (possibly even a ride because I'm claustrophobic and may need to be sedated), and then find out that they can't do it because of the IUD.

drjeff - Is it true that amalgam fillings can heat up during MRI? That's another thing I read. I believe I still have 2 amalgam fillings.

BTW, I'm typing this while sitting in my old pair of ski boots (new pair will be picked up this afternoon). It's almost as bad as summer jonesing....

The biggest difference between and MRI image and an Ultrasound image (even the new "4-D" ultrasounds that so many pregnant women get the pics of their babies taken with) is the degree of resolution that each machine can deliver. The ultra sound can give a good image of larger structures generally speaking. The MRI can give a GREAT image of both large and small structures. If your Ortho-pod is starting to think of a small tear (and by small you very well may be talking a few millimeters), you're likely not going to pick that up on an ultrasound, whereas with the resolution of an MRI image, your chances are much better of seeing it.

As for heat and amalgam fillings and MRI machines, as long as the radiation beam is focussed directly on the fillings for a LONG period of time (we're talking an hour plus), its of no issue whatsoever. Even if there is a constant, extended MRI beam exposure(lets say for a full head imagining session in multiple planes - and MRI can produce images in both vertical and horizontal axis's(?sp) depending on what you tell the software to do), the risk of tooth damage from the residual heat exposure is EXTREMELY low (prolonged heat to a tooth with a live nerve in it can potentially lead to nerve death in that tooth - that's why when my type of folk pick up the drill and start working that all that COLD air and water are emmitted from it, so the nerve stays cool and healthy)

If claustrophobia is an issue AND you Orhto-pod wants an MRI, many imaging centers nowadays have what's called an open MRI where the housing around the imager isn't as nearly "tube like" as the traditional MRI machine. Plus as Paul said, if it just a knee their looking at, even with an old machine your head would be out of the "tube", unless of course your a midget

An Open MRI machine:

and "old school" closed MRI:

 

[wa-loaf]

An Open MRI machine:

and "old school" closed MRI:

Wow, those are nice MRI machines. I felt like I was in the bat cave yesterday and that's not even the MRI machine. I had to cross over a little bridge and there were industrial looking rolling garage doors with some weird padding and bare cinder block walls. And then the control room with the MRI in another small room looking like it was just stuck in the wall.

 

[severine]

Wow, those are nice MRI machines. I felt like I was in the bat cave yesterday and that's not even the MRI machine. I had to cross over a little bridge and there were industrial looking rolling garage doors with some weird padding and bare cinder block walls. And then the control room with the MRI in another small room looking like it was just stuck in the wall.

:lol: That's quite the mental image! :lol:

Still waiting on their call.... I have to leave in about an hour to run some errands so I may miss them today.

On the upside, knee feels better today. Yesterday's increased pain was likely due to the manipulation at the appt. There's hope!

 

[drjeff]

:lol: That's quite the mental image! :lol:

Still waiting on their call.... I have to leave in about an hour to run some errands so I may miss them today.

On the upside, knee feels better today. Yesterday's increased pain was likely due to the manipulation at the appt. There's hope!

See, all you need to do is just hop around on your good leg all day and you've solved your problem without having an MRI either

You'd even still be set for skiing!

On a side note, just seeing any disabled person out on the hill enjoying the snow is awesome, but if you've ever seen the national/world class disabled skiers competing, WOW! The majority of them would out ski about 98% of the skiing population! They can really rip!

 

[wa-loaf]

On a side note, just seeing any disbleable person out on the hill enjoying the snow is awesome, but if you've ever seen the national/world class disabled skiers competeing, WOW! The majority of them would out ski about 98% of the skiing population! They can really rip!

I'd still want to ski if I (god forbid) lost a leg or even both.

 

[Warp Daddy]

Got a guy at our regional hill who skis with one leg and outrigger s on the pole --this dude RIPS and on the steeps -------AWESOME skier