Question
Hi Dr Durnin

Hope this doesn't blow your mind.

Before I ask my question, let me give you a history of my orthopaedic nightmare.

I am 28 years old.

Please be aware at all times that my problems started when I was about 9 years old.

I was diagnosed with osteoarthritis in 2002.  In July 2002 I had a total knee replacement.  Before this operation, however, I had undergone a total of 17 operations between my left and right knees (this was due to mis-diagnosis, and therefore the incorrect surgeries being performed).

In 2005 I was diagnosed with rheumatoid arthritis.  After looking at my history, I was advised by my now orthopaedic surgeon and a rheumatologist that by what I had explained to them it appeared that my condition had started as chronic juvenile arthritis.

At the end of 2005 I had to have a total knee replacement on my right knee.

In the last 2 years I have been suffering terribly with synovitis in my hips, and in the last few months in my feet.  I have had arthroscopies of both hips, and the synovitis is so chronic that I am in desperate need of a double hip replacement.

My surgeon specialises in knees and hips, and I therefore sought the expertise of his partner, who specialises in feet.

At the time that I saw him my problem was only in my left foot.

But before I go any further, let me give you an idea of the other problems I have with my feet.  I have flat feet due to dropped metatarsals.  Every six weeks or so I pay a visit to my podiatrist, who has to cut corns out of my feet.  The corns often get so bad, that once he has removed these he finds that blood blisters have developed under the corns, and then has to remove those too.  I have worn orthotics for the last eleven years of my lives.
It is a nightmare to go shopping, as I am in agony within approximately 15-20 minutes.  I cannot stand anywhere for longer that 10 to 15 minutes at a time as I find it excruciating to do so.

When I saw the surgeon with regards to my left foot he found that the I had chronic synovitis in my left foot, which has now started in my right foot too.  I cannot stand, I cannot walk, driving is excruciating, and even just sitting at my desk/on a chair/on the couch in front of the TV is an absolute nightmare.  The surgeon has admitted that I am a candidate for ankle replacements but that I am obviously way too young at this stage.  He has suggested a synovectomy.

HOWEVER, upon discussing this with my other surgeon (the hips and knees guy), he feels that this shouldn't be done and I'll explain why.
They now both feel that a synovectomy is going to be temporary relief, and they "don't want to put me through the pain and discomfort of surgery (please, I have been through alot worse - what do they think I am).
They want to inject the joints with cortisone.  My problem with this is that we (the hips and knee guy and I have established that these injections DO NOT WORK.  The "temporary relief" the injections give me last for approximately 3 to 4 weeks.


I am already on medication for my arthritis, being the following:

Methotrexate, Salozopyrin, and the obviously Folic Acid.
Now they want to load me with cortisone (on a daily and continuous basis as well).
I have also recently discovered that I am glucose intolerant and possibly diabetic.  So giving me cortisone would obviously not be in option in this case.

Please note that I also have other chronic conditions:

Asthma
Epilepsy
Underactive thyroid
High Blood Pressure
Urinary Incontinence
Glucose Intolerance
Bipolar Disorder

I also underwent brain surgery in April of this year.

On top of all the medication I am on, they now want to add daily cortisone, which I am not happy with.

I know I have bombarded you with alot of information.  I have asked my podiatrist for his opinion, as I value what he has to say.  But I need answers, I need solutions and I need these doctors to wake up.  I live on Lentogesic/Synap Forte/DF118/Temgesic and Duragesic patches.  The pain is having a MAJOR effect on my depression, which is getting worse on a daily basis due to this pain.

I need a solution, I need answers and I need to go to these doctors with something.  I am seeing them on Thursday, 25 October.  

I would appreciate an answer from you that I can take to them, if possible.

PLEASE HELP - I'm desparate!


Answer
Hi Joanne,

I feel very bad for you and hope I can help. What needs to be focused on is the big picture, multiple surgeries only add scar tissue and do not address the core issue. Obviously there is a problem with your genetic sequencing or genome.

You need to have a comprehensive food allergy panel performed and consult with a specialist at this site.


http://www.genome.gov/

Many countries are more advanced then us in gene therapy because of embryonic stem cell research restrictions presently in place in this country. Other developed nations such as India and Hong Kong have no restrictions. I do believe adult stem cell and embryonic research is still going on at full tilt in this country, just without federal funding. So going to these other places isn't necessary since they share their knowledge with us, or we get it other ways. ;)

Continuing down you're present path will only lead to more problems. the cause has to be identified and treated. Juvenile rheumatoid is a gene issue and I am sure there is some excellent resources on advanced gene therapy at that site. Your multilayered issue goes far beyond the scope of any one doctor, you need a team of specialists that can get to the bottom of your auto-immune response issues. This starts with advanced new medicine at that site, consult with them about the next step and keep in touch, I am intensely interested in what they tell you and what you find out. In the very near future, conditions like this will be curable, I hope and pray you can hold out that long. It is coming, see if you can get into a study or clinical trial through the genome center and get back with me. Don't let them hack you up anymore, this can lead and will lead to irreparable damage that can not be effectively treated in the future.

Good Luck and please stay in touch!

Dr, Timothy Durnin

UPDATE: 10/31/07


Please ask another question, I have more info for you,

thank you!

Dr. T