Hylagan® knee oil!

Updated January 2002
Well, the Synvisc was all used up so I went to the local Orthopedic Knee Oil Replacement center and had some Hylagan injected this time. (If you haven't read about my experiences with Synvisc, click the link following this update.) The program is pretty much the same, 3 injections spaced roughly a week or so apart.

Shot 1: Except for the needle poke (actual needle lengths may vary, but mine looked like a lawn dart) things went pain free.

Shot 2: Same as shot one, and actually the poke wasn't that bad this time.

Shot 3: This is the one I was dreading, you know that whole "Third times a charm, watch your knee explode" thing. All went well though and although I did limp out of the Dr.'s office the stiffness went away quickly.

It has been a couple weeks now and I am waiting for the juice to kick in, but have not noticed any significant pain relief yet.
One thing about these injections I have noticed is, for a few days after the injection my knee feels very fluid, almost too loose, but what gets me is the increase in the grinding sensation (different than normal though), I believe it is because all the little particles that have been grinding off lately are now floating free in new habitat, while the fluid disperses. Who knows? My doc says "sometimes it has to get worse before it gets better". I volunteered to stick him in the knee with a needle, but he declined.

So what now? I guess I wait and see if any relief is felt. If so, go back and get more after this wears out, and put off the bionic knee for a little while longer. If it doesn't? I don't know, "Better living through chemistry"?

So you've read the story and you feel my pain (maybe). I heard about Synvisc from my doctor and from some research I did. Synvisc is a synthetic synovial fluid (the stuff your joints float in) manufactured partially from rooster combs, I believe. There are a few other brand names and slightly different injectables that are designed for supplementing the bodies natural synovial fluid.
Generally the treatment involves a series of three injections over three to four weeks, with the results becoming noticeable about 2-3 weeks after the last injection.
Synvisc is normally fairly well tolerated by the body with little side-effects.
If you have insurance, check with them first as most programs don't consider Synvisc a drug, but falls under some other category. I went around the block and back with my insurance and doctors office to get the coverage straight.

I received the first injection and apart from the initial needle poke had no other problems and figured all would go well. A week or so later I received the second injection which hurt immediately upon entering my knee and my knee remained stiff and sore for about three days, but I could still walk. I thought the Dr (who I think is more than competent) probably just injected it too fast or something. The liquid itself is pretty thick. I guess it has to be, to be good knee oil.

So finally, I get the third injection. I asked the Dr. to squirt it in nice and slow so it wouldn't hurt like last time and he obliged. It seemed to go better with only the discomfort of being poked with the needle to complain about.
Well later that evening my knee started hurting a little, then after crawling into bed it started hurting a lot. By the early AM (zero dark thirty) I was begging my spouse for (no not that)
an ice bag as my knee had begun to swell. By daylight my knee was swollen twice it's normal size and continuing to grow. It's a good thing skin is pretty elastic. So of course I call the Dr. but he's in surgery but manages to call in a prescription for some pain meds but can't see me that day.
I kept ice on it and took part in the "better living through chemistry" plan for that day and night until I got to see the Dr.

For those who haven't experienced it, when a joint swells up that much it means it's full of fluid of some type; blood, water, gunk or something. And that stuff has to come out before your skin stops being elastic. Without going into details, let's just say the process involves more needles and you start out with empty syringes. I was a little upset, cause the Synvisc is pretty expensive (even though mine was partly covered) and here it just got sucked back out. I even thought I was starting to get some relief. The Dr. sent some of the extracted material to the lab to check for crystals and other things. He scared me by saying if it was infected that I would have to be checked in the hospital immediately to "clean it out" surgically. Fortunately the results indicated that hospitalization wasn't necessary. (insert brow wipe here)

Turns out that I had some kind of "pseudo gout" and the Dr thought it wasn't related to the injections but I think different. My experience was rare as most people have had few problems with the injections themselves. As for the results, I think the two and a half shots I got actually provided some relieve. My knee felt more lubricated and less grindy than it has in years. The relieve lasted for approximately 4-6 months. Was it worth it? Yes, I enjoyed having better mobility and less pain just from everyday stuff. It didn't erase the pain completely and my knee wasn't like the original, per-injury one, but it did make a difference.

The Dr says we can do it again but I am kind of scared of the inflating knee thing, so I am going to tough it out for a while.
I heard they are making new arthritis pain medication from snake venom, maybe I'll try that...

The Story

I used to be a wakeboarder. I loved wakeboarding, it was fun. Just like doing tricks on a snowboard, only the boat and rope make some things much easier.
Like doing flips.

It was going to be a beautiful weekend, the sun was to be shining on the West side of the mountains and I was on a roll at the tournaments I had been going to. I was winning or placing at most of tournaments and was to go to the National Championships that were happening in a couple weeks down in Texas. Most of the competitions around then were Slalom and Freestyle. This was 1994.

I left my Sunny side of the State and headed West to meet up with my friend Eric, go wakeboarding, then visit my girlfriend (now my wife) who was also on the West side of the hills. I arrived in the mid afternoon and met my buds, we hooked up the boat and went to Clear Lake. I don't know exactly why they call it that because it seemed to have a lot of plant life. We each took a turn on the rope. My turn came around again and I had been getting really close to pulling out a back flip. I rode for a while, threw a few grabs and rotational tricks, then I was ready to quit, but they said go for one more. I went for the back flip. I pulled out wide and went for the wake. There was another boat near by, so I timed it just right to show off for them. I hit the wake, flipped, landed compressed but landed it, but ... It hurt a lot! I had to let go of the rope and didn't ride it out.

The board was still on my feet but my knee felt painful. I could still move it; it was just a little stiff. I got the board off and my friends helped me in the boat. It didn't feel to that bad, just shocked a little from landing flat on the water and compressed. I volunteered to drive for their turns. It started to get dark and it was time to put Eric's boat back on the trailer. Since I had towed it there, they asked me to go get my truck. Unfortunately, by that time my knee was twice it's normal size and hurt so bad I couldn't move. Eric had to get the truck, which I couldn't drive then either (I have a clutch). After a very painful trip (they carried me) from the boat trailer to my truck (About ten feet), we went to Eric's house to park the boat and apply some ice to my knee.

He didn't really have any ice but his wife, Gretchen, kindly applied a bag of frozen corn to my knee. After an hour, the swelling was not going down so they offered me a ride to the hospital. They put me in the back of their mini-van and were off. The ER in their small town was not exactly hopping with activity so I got seen right away. They also conveniently had an orthopedic surgeon on duty. Lucky me. The pain was incredible. First the Ortho doc, a nice looking woman by the name Dr. Lange, filled 3 of largest syringes I had ever seen, with the blood gathered in my knee. The act of sucking blood out of ones knee with a needle is less than pleasant, and I don't recommend any part of this experience to anyone. Then came X-rays and the verdict. I thought if it was an ACL, I could be recovered in time for snowboard season, and get right back in to things. Not exactly.

It turns out I had fractured my tibial plateau, creating a large crack which stopped just short of breaking off the whole top of my tibia. OUCH. In the same process I also managed to completely crush the cartilage and meniscus of that knee. There went the hope of Nationals, and there went the snowboard season. Snowboarding is my first passion and I was extremely bummed. And although the pain medication dulled me somewhat, the prospect of having no insurance and requiring major healthcare was not very pleasant either.

The fine doctor offered to keep me there and in a few days take a chuck of bone out of my hip and put it in my knee, but I declined and had my girlfriend take me back East of the mountains for a second opinion. The doc in my hometown was good and said he could do it without the little bone chip out of the hip part. He did the surgery even though I didn't have insurance and the hospital even cut me a little slack on their bill. But it was a long painful road back to walking.

It was late summer when all that happened and after a couple months of lying around I moved up to crutches. I spent one the best snow years to date working at a ski area, resting on my crutches, staring out the window. It was a long season. In the spring, I had a second surgery to clean up the debris in my knee and to remove the screws which had been holding the upper part of my tibia together. I was even able to get in a few very timid groomer runs near the end of the season.

Things started feeling a little better and in the spring when all the snow melted I got a job at a major waterski company. I thought I was all better. I started wakeboarding again, doing product testing, and just having fun. I got a chance to ride with a lot of pro riders, which made me want to go all that much bigger on all my tricks. I never really got that much better at wakeboarding but I was having fun. Then the knee started hurting again. I decided to ignore it.

Well, a few years later, even though I officially retired from wakeboarding, the constant daily pain, not to mention the after-snowboarding pain, got to me. I went to see another doctor.

Well after going through the HMO shuffle (I actually have insurance now), I met with a very highly recommended Orthopedic surgeon. He said I was looking at a total knee replacement. After a few more visits we decided I could go with a Hemi or partial knee replacement, but that given my relatively young age now (33), I was looking at several knee replacement surgeries in the future years.

That brings us to the present. Now I have to make up my mind when to do this. It's winter and it's another banner year for snowfall.
Last year we got so much snow that my ski area had to close for a few days just to dig the lift towers out enough to let the chairs move!
The doc says I could put it off for about 6 months to a year max. But snowboarding will shorten that some for sure, especially the terrain I like to ride.
What to do? After I get this done, I won't be able to go at all, ever!