LaurenDoctor: Navin D. Fernando, M.D.
Sometimes one footstep can lead to a long medical journey. For Lauren F. 66, her journey started when she took a step and twisted her knee at work. What Lauren didn't realize was this step was the beginning of a medical voyage through two knee replacement surgeries and more.
Lauren's misstep caused a meniscus tear in her left knee, a common knee injury that many patients may recover from with time and rest. Meniscus tears which don't heal may predispose patients to develop arthritis, which is what likely happened to Lauren.
Lauren underwent arthroscopic surgery to clean up the meniscus tear, but unfortunately was still in pain after six months. "I struggled with my left knee, which developed arthritis from the injury," Lauren said. "My right knee had to compensate, and after months of doing that, it also hurt me."
Arthritis pain begins with thinning or eroded cartilage, which typically functions to cushion and protect the knee joint. If the bone in the knee joint becomes exposed, sensitive nerve fibers can become inflamed resulting in significant pain. Currently, there is no reliable way to replace normal cartilage. Lauren endured the pain for two years before deciding to have a left knee replacement in 2013.
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During a total knee replacement surgery, the damaged cartilage (about a quarter inch) is removed and replaced with an artificial joint made of metal. A very smooth plastic bearing is placed between the metal pieces to allow the knee to move normally. The artificial joint is attached to the thigh bone (femur), shin bone (tibia) and knee cap (patella) with rigid bone cement, which allows patients to walk and weight bear immediately after surgery. The bones, muscles and ligaments around the joint are not replaced, which provide support for the prosthetic knee and allows it to function normally.
"Who wants to have a knee replacement?" Lauren said. "The pain was not only debilitating to me daily by limiting my mobility, it was exhausting me, and over time that gets you down."
Although her surgery on her left knee went fine, her recovery was difficult because the anesthesia and pain medications made her very ill. Adverse reactions to these types of drugs include nausea, vomiting and dizziness.
One year later, when the left knee had enough time to mend, Lauren needed to have her right knee replaced as well. She weighed the positive benefits of a new pain-free knee against the uncomfortable effects of the pain medications.
“Recovering from the narcotics almost scared me more than having my right knee replaced,” she said. "I didn't want to have that experience again." In the end, she decided to go for the right knee replacement.
Lauren searched for a surgeon who would listen to her fears and partner with her to find the right solution. She found her perfect match in Dr. Navin Fernando, from the UW Medicine Hip & Knee Center at Northwest Hospital, who specializes in the evaluation, management and surgical treatment of hip and knee conditions.
"He listened to my concerns and even read the three-page article I brought to him about an alternative way to medicate so you don't have to use heavy duty narcotics for surgery," said Lauren. "When he said he used the protocol described in the article, my confidence level shot up and I knew I would get through the whole ordeal. Dr. Fernando is an excellent listener. He and his whole team care."
Dr. Fernando set up a special consult with Barbara Dailey, a nurse practitioner and pain specialist with the UW Medicine Northwest Hospital Surgical Pain Service. Together, they worked to come up with a new drug protocol so Lauren could have the surgery and heal without the medications that made her sick after her first knee surgery.
Patient-centered care and shared decision-making are important philosophies in Dr. Fernando's practice. "Dr. Fernando's staff followed up with me over the weeks following surgery. The whole process went so well and I credit Dr. Fernando for my pain-free life today," said Lauren. "It was a positive experience."