Why Not Replacement?

Given the large number of people who have had successful joint replacements, why not go with the surgeon and have my right shoulder done immediately? Good question.

Unless it is an emergency, I think it always better to take the time to review options, get second (or more) opinions, and make an informed decision about any medical treatment. Remember, the person ultimately responsible for your health is you, and it is incumbent upon any responsible person to be informed and to make informed decisions.

In this case, there are several factors at work.

Back the second time I worked for NASA (as a contractor), I worked commercial space research and as part of that worked with the Center for Commercial Applications of Combustion in Space. The team there was working with partners on advanced bone replacement materials. The problem with the implants then (and it applies to current day as well) is that they are solid chunks of metal or other similar materials. Natural bone may be smooth on the outside, but inside they are quite porous. Thus, you have density and mass differences that can and do affect the system on a mechanical basis. The stem of a replacement has to be glued in place, and that has caused problems on occasion.

The work CCACS was involved with produced a metallic/metallic-ceramic replacement that was smooth where needed, and had a porosity effectively equivalent to natural human bone. The research was focused on how to get the same results on Earth so that custom replacements, as close to identical to what was being replaced as possible, could be produced on Earth in the OR. Since the reaction was exothermic, the replacement parts would be sterile.

The truly advanced work, however, was focused on developing materials that would serve as a scaffold for natural bone to grow. As the patient’s bone grew into it, the replacement would dissolve and pass out of the body until after a period of time the patient was left with natural healthy bone in place.

There is a good bit of research underway (see here for one example) on advanced materials. Such advanced materials are needed because of a different area of medical research: regenerative medicine.

Regenerative medicine uses things such as stem cells, the extra-cellular matrix, and even some genetic manipulation to heal. In fact, using regenerative medicine, it is possible to not simply heal, but to restore a site, organ, limb, etc. to what it was before. Ultimately, they are looking at being able to regenerate limbs, organs, and other structures. To call it an exciting field is an understatement.

While separate, regenerative medicine ties into a variety of anti-aging research. This research focuses on restoring the body to the cellular conditions of youth.

Now, having worked with such research at NASA, and having had the honor of working with the late Leslie A. Geddes at Purdue — who pioneered several fields of biomedical research including regenerative medicine — I’ve been keeping a bit of an eye on such things. As Glenn Reynolds the Instapundit often notes, “Faster, Please.”

And I do want to see it faster, much faster, please. Based on current research, and even allowing for the FDA approval system that seems designed to prevent advances and competition, I believe I have a good twenty to forty years of life ahead of me barring something catastrophic. Which gets back to the current state of joint replacement.

Current materials are not designed to take advantage of future advancements. Nor are they designed for the life of the patient. The sad fact is that for many types of replacement, you can count of having to have the replacement replaced about every fifteen to seventeen years. So, at least two if not three replacements.

I would also note that because of the issues connecting bone with replacement, I would be limited to picking up no more than 15 pounds at a time, not have full range-of-motion restored, and face other limitations on activities. This would include many things I enjoy doing. Add in that at least two people I’ve talked to who have gone this route would not do the replacement over again, well…

So, I could opt for immediate replacement with parts that are close/semi-close to the size of my bones and will limit my activities because of the mechanical and other differences. These parts also are not designed to work with near-term or long-term advances in medical treatment; but, the replacement would reduce (though not necessarily eliminate) the pain in the joint and prevent further damage.

Or, I can opt to wait and experiment. The experimentation is potentially two-fold.

The first part is to try a supplement regimen that could slow, or even stop, damage not just in my shoulders but my entire body. Such a regimen has reportedly resulted in healthy regeneration (to some extent) in some patients. The odds, as I understand them from medical research, are long. I’ve faced some long odds in life before, it’s worth a shot.

The second part is to research clinical trials in regenerative medicine and advanced bone replacement materials. If I qualify for one or more regenerative medicine trials and participate, then I have the potential for at least partial restoration if not full. Add to it the fact that by participating I can help drive things forward faster please, even if it does not help me, then it’s still a win.

If regenerative trials don’t work out for whatever reason, then I will look to advanced bone replacement materials trials. If I have to have a replacement, why not go for one designed to take advantage of advances in medical technology?

Meantime, I’ve lived with chronic pain for years, decades even. I don’t like it, am working on dealing with it, but can handle a bit more. So long as I minimize damage to the shoulders and other joints being attacked by arthritis, I can and will put up with the additional pain.

That’s it in a nutshell, and there are several areas that can, and may be, explored in greater detail later. However, for now, it lays out the base case for my decisions.

He’s Not My Cat

I, however, am his Designated Emergency Human and according to Cappie (short for Capt. Neurotic, my name for him) a permanent state of emergency has been declared. He cries at my door some nights, begging for me to let him in. Usually, he’s waiting for me when I get up. If I get up other than at my normal time, he comes running, which you see here. If it hadn’t been for the light, you would see this odd little thing he does as he turns the corner.

Grrrrr. Not letting me post the movie, will work on it and update later.

So Much Going On

There is so much going on in the world, from the shit show that is media coverage of American politics to the various bits of tawdry sadness that is “news” via celebrities. I pity that hapless teen from Sweden, and fully agree with those who hold her parents and other handlers in complete and fundamental contempt. Against that background, it is easy to let gloom and despair fill our view. It is easy to believe that we are doomed on one or more levels.

It isn’t. The media bubble does not reflect reality. Reality is much more upbeat and happy. When you are out of the bubble, you see people coming together and doing good things. You see stories like this one, or the very definition of sang froid that is Texas Man. Reality is full of stories like this.

Yes, we are in a fight as to the direction of the Republic. It is important. It is also important to realize that outside the media bubble, people still are willing to listen, to help each other, and do those things that have made — and can continue to make — the Republic a success. Discourse is still possible, outside the bubble.

I’m not going to post today about health or anything else. Instead, a quick challenge: go commit a senseless act of beauty. Pay it forward, complement someone, take a photo and share it — just do something positive. As you do so, get outside the bubble for a bit. You will be amazed at how much better you feel and how energizing it is.

What Is Arthritis?

Actually, that’s a very good question. It’s one that I wish I had asked a long time ago.

The term arthritis actually refers to more than 100 different types of arthritis and related conditions. The two most commonly diagnosed types of arthritis are osteoarthritis and rheumatoid arthritis. While arthritis primarily involves joints, certain types can also affect major organs.

The damage to joints can be mild to wild. On the milder side are stiffness and soreness. On the wilder side, the cartilage can be completely destroyed and the bones of the joint damaged both by inflammation and by rubbing against each other.

There are a number of factors that go into arthritis, from family history to injury. Even infections can result in arthritis in joints. In my case, some things I was exposed to as a small child put me at a higher risk of inflammatory problems. Add to that my having done things like jumping out of planes, rappelling, and other activities and you get a good chance of developing arthritis. And bone spurs.

In my case, it would appear that something has caused my osteoarthritis to become very aggressive in my shoulders. So much so, I’m going to be asking the rheumatologist I’m seeing in January if that diagnosis needs to be refined.

The X-ray of my right shoulder shows that the cartilage is gone; the bone ends look like the lunar landscape (with some small bone spurs acting as mountains); and, a chunk of my humerus is missing. That missing piece is most likely the piece of bone seen trying to work it’s way down towards my chest. The left shoulder looks better, but not by a huge amount.

There are a number of treatment options for arthritis. For my “just” osteoarthritis, I’ve been taking a drug called Meloxicam for the past three years off and on, and it has helped with some of the inflammation and related issues. Looks like more may have been needed. In addition to my shoulders, I have symptoms starting in my back and neck.

In the experiment I am starting, my goal is to do all I can to help my body heal itself. The best outcome is that through what I do is to reverse the damage. The middle-case outcome is that I help as much as I can on the shoulders, and slow or stop progression elsewhere in the body. The worst-case outcome is that over the next six months I generate very expensive urine courtesy of the supplements and things continue as they are.

The odds are not good. In fact, I’ve been told that the odds of any one supplement working on my condition (and with my genotype, etc.) is less than ten percent. That said, if I don’t make the effort, I will never know if anything could work. There is also the fact that by taking multiple supplements, I run the risk of side effects. To help reduce that risk, I’m keeping my primary care physician aware of what I’m taking and will be requesting some extra blood tests to be sure I’m not causing problems rather than fixing them. In particular, I want to monitor the amount of calcium so that I don’t spike it.

Then again, I’ve beaten long odds a time or two before. Nothing ventured, nothing gained.

Getting Back

Yes, I am working on getting back to writing regular posts here. I’m also focusing on getting back in other areas of life.

About five years ago, I was given a mistaken diagnosis of cancer. While I thought it was wrong from the start, I upended my life to deal with it. I stepped down from Mission: VALOR, and stepped away from a number of other things. I thought having a procedure done that proved by biopsy that I did not have cancer was the end of it. However, I just spend the last six or so weeks having to re-prove I did not have cancer because a doctor who diagnosed me by looking at me put it into a major (local at least) medical system that I had cancer.

Add in a botched colonoscopy that resulted in an ER visit, the administration of epi, and a few days in the hospital (and cost me a job), along with some other things that happened, and it’s been quite a time. I’m told that God does not give us more than we can handle, and for all I do believe that I also get the impression that God thinks I’m a bigger badass than I think I am.

Now, I have another challenge that I will be blogging about some each week. I’ve had chronic pain for a few decades now, which is not the issue save that by the time this issue was something I noticed, a lot of damage was done.

A few years back I was diagnosed with “just” osteoarthritis. Just. Well, it has done a number so that three weeks ago it was recommended that I have an immediate replacement of what is left (not a lot) of my right shoulder joint, and that I will probably (according to the surgeon) need the left done soon too. Oh, and a piece of bone that broke off in my right shoulder joint is now trying to work it’s way down into my chest.

I consider a total joint replacement using current tech to be a less-than-optimal solution. In fact, I think it a very bad idea for reasons I will lay out soon.

Instead, I am conducting an experiment on myself to see what can be done with supplements, despite the fact that the best of them work on only about thirty percent of the population and many of the more specialized supplements appear to work on less than ten percent. Again, more to come on this as part is on what can be done for the shoulders and the rest is to see if we can slow, halt, or reverse some of what is going on elsewhere.

I’m also working to see if I can get into some clinical trials involving regenerative medicine; and, if that fails, clinical trials for advanced bone replacement materials. I will share more as I can, as well as trying to get back to commentary on space, national defense, and other issues.

Your patience is appreciated, as is the readership of the couple of you who still show up here.

Not Surprised

Unfortunately, with two things.

First, the death of Jeffrey Epstein. Conspiracy and murder, or just more proof of the incompetence and abrogation of duties of our governmental institutions? I wanted him alive, as the man had a lot more information on more than the sexual foibles of a lot of people. It would also have been very nice to see his victims get some satisfaction.

Second, I can’t even say I’m disappointed in Beto. He did the right thing, for at least an hour or two, before joining every other democratic candidate and leader in politicizing the shooting(s). Screw the lot of them.

El Paso & Ohio

While the 48-hour rule is in effect, there are a few points I can share.

  1. Gun Free Zone = Target Zone.
  2. Carry. Legally.
  3. Carry first aid gear, including tourniquets.
  4. In regards 2 & 3, always carry.
  5. In regards #1 and similar things, better to be tried by 12 than carried by 6. Be smart, talk with a good lawyer, and be prepared.
  6. In an emergency when seconds count, first responders are only minutes away. Be prepared.

At least two of the democratic presidential candidates have responded as expected, fornicating the corpses for political gain before they were cold. Confirms my thoughts in regards both of them.

That said, if what I am hearing is true, my hat is off to Beto. I had no respect for him (rather less than that actually); but, he has suspended his campaign to return to his district to do what he can for the people he represents/represented. That is the right thing to do and is truly stepping up. Bravo, and at least one got it right.

Meantime, all I can do is offer my thoughts and prayers to those killed and injured, those around them, and those who responded to these incidents and/or are treating the victims.