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Showing posts with label Recurrence. Show all posts
Showing posts with label Recurrence. Show all posts

Wednesday, October 3, 2012

Building Resistance to PVNS Tumors



{Correction 02/13/2013): 6 mo f/u MRI 06/2012 showed a false pvns recurrence. It was proven during f/u surgery 12/14/2012that the mri was showing scar tissue and not pvns. After you have surgery the mris become more difficult to read accurately. After the 6 mo f/u mri I had two more mris done showing that the (false) pvns was remaining stable (unchanged) that was the clue that it was scar tissue and not pvns.} The tests that I referred to in this article all came back good. I do not have an over or under active immune system nor anything besides osteoarthritis from age and pvns.

Being a Pioneer

I am well aware that we are all guinea pigs and it doesn’t matter what treatment we choose. On a positive note the more data that is collected increases the chances that a common link could be found. I commend everyone who is willing to try adjuvant treatments because you are the pioneers that may someday make a cure possible. Note please make sure your physicians are sharing your information (positive and negative) with researchers and not just keeping it in their private files. 


MRI Report of  a False PVNS Recurrence

Why did my treatment regimen fail when others (approx. 80%) with the same amount of PVNS, damage and treatment remain in remission? During surgery the joint was visualized arthroscopically then an open complete synovectomy was done. My orthopedic oncologist is a top rated surgeon familiar with pvns. She removed all visible signs and areas that showed on the mri. I followed up with 18 treatments of 200 greys each which would have disabled . My six month follow up mri showed a new area of recurrence. Something is making my body more susceptible to the pvns and until that is corrected I’m afraid it will continue to recur, destroy my joint as it has caused the chondromalacia to worsen in just one year even with surgery. 

The cellular composition of diffuse pvns is exactly the same in each individual so this means that pvns itself has the same strength and destructive properties in everyone. What makes some bodies more susceptible to a recurrence? I have arthritis in both knees and throughout my spine that is well out of proportion to my age and lifestyle. 
I’m working with a research arthritis specialist who is running many tests to see if I have some type of defect that makes me more susceptible to arthritis and or pvns. I am also working with an immunologist who is checking to see if there is a link via the immune system. some of these blood test take a month to get the results so I will post any information that they may provide. For now the doctors are trying to build up my body as much as possible immunologically by addressing my allergies (they have already done allergy testing for which are minimal), with diet (I’m looking into cancer diets), and supplements including Vit D because it was very low and low vitamin has connections to tumor growth. Hopefully along with what they find out from the blood tests I will be in better shape to resist future tumors (recurrence) after my next surgery. 


I am not a physician and the above is in no way to be taken as medical advise. This is my interpretation of what I have been told by my physicians and from what I have read. Always consult with a professional for case specific accurate information.


Friday, June 22, 2012

PVNS False Recurrence & Angry




(Correction 02/13/2013): 6 mo f/u MRI 06/2012 showed a false pvns recurrence. It was proven during f/u surgery that the mri was showing scar tissue and not pvns. After you have surgery the mris become more difficult to read accurately. After the 6 mo f/u mri I had two more mris done showing that the (false) pvns was remaining stable (unchanged) that was the clue that it was scar tissue and not pvns.


For the peeps that are new to this or just had surgery...I don’t mean to scare you or come off negative but I’m seeing way too many people with negative outcomes and I’m angry. I feel discouraged after spending nearly $40 grand ($1750 out of pocket), I have more pain in my knee post surgery, radiation therapy induced tendinopathy, manipulation under anesthesia, and six months off work to get rid of and recover from this disease... only to have it reappear with more of a vengeance within six months. Due to the extra strain my good knee now has an effusion (no pvns) but it is swollen and hurts all of the time. Now 2 bum knees. Thank goodness for insurance.

I know that the treatment decisions I made gave me the best chance of recovery (15-20% chance of recurrance), however, treatment seems to have been a total failure. Now the diffuse pvns appears to be in a new area within the intra-articular notch and within the bakers cyst which is enlarging again, synovitis has recurred and to top it off I have radiation induced tendinopathy in my knee. How can this happen so rapidly and what next?  The docs would be much more accurate in saying “there is a 100% chance that pvns is going to fuck up your life or not” no matter what treatment choices you make. Where are they getting their figures anyhow? How can there be a 9-45% spread in recurrance statistics? To me that is a useless statistic. I understand error margins but that is ridiculous. I think to myself “how bad would it have been if I hadn’t treated it aggressively but on the other hand I wasn’t in pain and only had minor swelling prior to surgery. What if I had just left it alone? Would I be better or worse off? I can’t help but to ask these questions.

On a positive note I have the worlds most supportive husband who loves me with all of his heart. He is stressed at work and now my health and financial situation causes more stress. He says no but in my heart I feel like I’m letting him down and not fulfilling my part of the responsibilities. I don’t feel good about me as a person when I’m not working and I can’t shake that.


I am not a physician and the above is in no way to be taken as medical advise. This is my interpretation of what I have been told by my physicians and from what I have read. Always consult with a professional to determine your individual risk factors. 

Thursday, June 21, 2012

PVNS MRI: False Recurrence at 6 months




(Correction 02/13/2013): 6 mo f/u MRI 06/2012 showed a false pvns recurrence. It was proven during f/u surgery on 12/14/2012 that the mri was showing scar tissue and not pvns. After you have surgery the mris become more difficult to read accurately. After the 6 mo f/u mri I had two more mris done showing that the (false) pvns was remaining stable (unchanged) that was the clue that it was scar tissue and not pvns.


I picked up the 6 month f/u report on the pvns knee as I was waiting to have an mri done on my per se good knee. My heart plummeted and my energy drained as I read that the pvns is back and also now in the tendons. “No!” flowed out as I exhaled. Realizing I was surrounded by strangers... I became quiet again. I kept reading the report over and over as if reading it again would miraculously change the words. 
If I actually believed in God I’d be saying “what the fuck” and blaming him. The truth is no one is to blame except for this bastard of a disease that insists on having a presence in my life. I’m just wondering “now what?” 
I already had an open synovectomy for diffuse pvns of the left knee in December 2011. Endured the severe fatigue and expense $26k of 18 radiation treatments at 200 greys each, causing adhesions to form. Then 4 1/2 months post op going back into to surgery to have manipulation under anesthesia done on my knee in order to regain movement. Along with all of this 4 1/2 months of PT. After all of this treatment my knee feels destroyed and knee pain now wakes me up at night along with the back pain. 
I was hoping for the best but my gut feeling kept telling me that my knee was not healing properly. It remained way too hot, swollen, stiff and painful for everything to be ok in it. I was hoping to be one of the lucky ones who are able to put pvns on a back burner and continue forward with life but obviously 20% recurrance wasn’t good enough odds for me.
I feel like I'm in a boxing ring and every time I get back on my feet another fist is smacking me in the face. I know that others deal with much worse situations but today I’m going to throw a pity party, pamper myself and rest before the next round.

SIX MONTH FOLLOW UP MRI
Referring Physician: Amalia M De Comas MD
SimonMed Palm Valley II DIAGNOSTIC IMAGING REPORT
Age:47 Diag. Imaging #990526
Patient: Jeffrey, Carol Status: Outpatient
Exam # 3245538 - Jun 18.'2012 - MRI - LOWER EXTREMITY JT W/O CON - Left
CLINICAL DATA: Left knee pain and swelling, history of synovectomy and history of tumor with radiation treatment in the knee.
COMPARISON: MRI Left Knee I ll7l20ll MRI TECHNIQUE: Multiplanar, multisequence imaging was performed without contrast. IMPRESSION:
1. New, diffuse thickening and intratendinous signal involves the extensor mechanism quadriceps and patellar tendons where AP dimension distal quadriceps measures 2 cm and mid fibers patellar tendon 1.4 cm. This may relate to rare intratendinous extension of pigmented villonodular synovitis, postsurgical or less likely, post irradiation changes, correlate clinically.

2. Joint effusion and synovitis again noted. Hypointense posterolateral signal abutting the tibia is not significantly changed. Mixed signal intensity along the posterior capsule appears stable with additional, 12 mm hypointense focus superior margin of the capsule which is new compared to previous study. Overall decreased size of popliteal cys! however, multiple foci of hypointensity present diffusely within popliteal cyst most prominent at the inferior margin. Suprapatellar soft tissues and region of previous hypointensity not entirely included on current examination. Findings most likely relate to residual focus of pigmented villonodular synovitis and/or recurrent disease.

3. Lateral meniscus degenerative horizontal cleavage tear body extending into the anterior horn is unchanged. No acute injury. Laterulmeniscus appears intact.

4. No acute ligament disruption. Stable mild tricompartmental degenerative changes where osteophytes and chondral thinning noted. No acute fracture. Additional soft tissue support structures grossly maintained.
dd: Jun 19,2012
Reported by: Janet Martin M.D. Electronically signed by: Janet Martin M.D


I am not a physician and the above is in no way to be taken as medical advise. This is my interpretation of what I have been told by my physicians and from what I have read. Always consult with a professional to determine your individual risk factors.