9 yr old LBHR and High Cobalt/Chromium levels

[izumichan1]

I had my LBHR done by Dr. DeSmet over 9 years ago. Since I have had no problems since then, I haven't been on this sight. About 2 months ago I suddenly started having pain as well as a lot of grinding and clunking.  This sight was very informative and helpful to me back then so I find myself here again in search of answers.

My recent X-rays show no problems. Cobalt/Chromium blood tests came back really high. However here is the confusing part. The joint suddenly feels a lot better. Not 100% but good enough to get off pain meds and function in my day to day routine.

 I live in NYC and work as a waitress. I walk all day long sometimes, bike a lot and do resistance training. I'm wondering if sometimes these things get better on their own? Also if anyone knows of any other options other than revision? I have heard the human body can flush out the metal ions. And does anyone know if there are any holistic or natural ways to neutralize the metal ions?

I also gained about 25 lbs recently after quitting smoking and I'm wondering if this has anything to do with it.

Dr. DeSmet instructed me to have an MRI w/MARS protocol which I will do but frankly I can't afford him this time if I do need surgery. I don't have insurance so even if I can squeeze another year out of this BHR I am willing to do it.

Whatever the outcome, 9 years is a good result so I am eternally grateful to Dr. DeSmet.

Izumi Tezuka
LBHR about 9 years ago
43 years old

[Pat Walter]

Hi Izumi

I am sorry to hear you are having problems.

Who did your blood test for you?

Dr. Su is one of the best in the US and has actually done a lot of revisions of other surgeons resurfacings.  You might want to have a consult with him.

Dr. Gross will also give you a free consultation if you send him an email with x-rays and blood test results.

The blood test is not done by many labs, so that's why I was wondering who did it for you.

Normally when patients have high metal ions, the surgeons always suggest a revision.  I am a 7 year BHR De Smet patient. Normally, I would not expect many problems from his hip resurfacings since he has done so many with such a great record.  Unfortunately, things can go wrong or happen some times. 

I definitely would get more input before tyring to decide what to do.

I don't know about any cases or medical studies about high metal ions going down without removal of the hip device.  I am not, however, a doctor and certainly don't know everything there is to know about metal ions.

Keep in touch.  Good Luck.

Pat

[izumichan1]

Hi Pat,

Thank you for your concern. My blood test was actually done by Elmhurst Hospital Center in Queens, NY. I went there for x-rays and consulted w/their orthopedic surgeon. I know he's not a specialist but they have a specialist Dr. Darwin Chen who comes 2x a month so I figured I'd start there.

I have been in touch w/Dr. Su. Not sure I can afford him but will definitely see what he says. Do you think he is in the same league w/Dr. Bose?

Thanks again
Izumi

[B.I.L.L.]

Good luck, I'll be following your post's to see what they say, hope you get it worked out !

[Tin Soldier]

Sorry about the problems, 9 years is great, but many expect to go a lot lonegr without troubles.

I would think Bose would have a similar exprience/knoledge as Su, but not sure about revisions.  He is one of the more known and experienced HR surgeons.  Most of the well-known docs have done their share of revisions.  I believe the BHR manual actually has a chapter dedicated to revision.  You should just ask the surgeon/surgeon's office about experience.   

How high is high for your Co Cr levels?  Something to consider is that 7 ug/L or so action level you see referenced by various medical agencies is designed to be an additional parameter that a surgeon would look at, along with images, fluid, pain, and other symptons to determine if the hip should be revised.  Those action levels are not based on systemic toxicity to the body, they are based on the fact that they are above "background" concentrations and they might indicate metallosis in the hip.  Sure, no one wants elevated heavy metals in their body, but the action level is very low compared to anything in the literature that would suggest toxicity to the rest of the body.  I guess all I'm trying to say is that just because your metals are high, doesn't mean that they will automatically affect the rest of your body.  Your body does rid itself of Cr and Co, unlike some of the other heavy metals.  As Pat pointed out they go down until the problem is removed.  I did see a paper once about an individual who tried taking some suppliments to reduce his metals in blood.  I don't think the results were very conclusive.

I think discussing these questions with a surgeon would be really benificial.  Good Luck. 

[izumichan1]

Thanks for the clarification about metal ions. I have actually been having difficulty understanding the whole issue. So much conflicting info. My Cro Ch levels were 69/84? Does that make sense? It didn't occur to me to ask what was the unit. I will ask at my next appointment

Izumi Tezuka
43 years old
LBHR

[Pat Walter]

Dr. Su is an excellent choice in the US.  I know he has done a lot of revisions. I also know Dr. Bose is one of the best in the world.  I would trust either.  You could most likely go to Dr. Bose in India for the least amount of money.  I think people have done the whole tirp, plane, hotel, medial expenses for $10,000 or under.  That is not too bad.  You might have to be like me in 2006 and put it on your credit cards if things are really bad.  If you need something done, hopefully there will be a way to get it done.  I know many of our hospitals in OH are non-profit and you can get a lot of financial help or discount if you are not making a great deal of money and have no insurance.  That is something you might want to look into if Dr. Su can help you.  Go to the financial dept of the hospital and ask what can be done.  Even for people making $30,000 in OH you got something like a 60% discount.  It is then stepped down to being free when you don't make too much.  I don't know how NY hospitals are, but you might want to check it out.

Good Luck.

Pat

[Tin Soldier]

I have seen folks post about Co and or Cr in the 100 micrograms per liter (ug/L or ppb) range and there was someone here that showed a solid decrease in metals concentrations over a year or so after revision from a problematic HR.  I assume your units are ug/L or the comparable medical unit, whicih escapes me right now.   Again, I would be sure to discuss the numbers with a surgeon, which should give you a lot more confidence about the situation.   

[izumichan1]

Had an appointment with Dr Darwin Chen of Mount Sinai yesterday. He is not a resurfacing specialists but he is apparently an up and coming joint replacement/revision surgeon so I figured it couldn't hurt to hear what he had to say. My chromium levels are 84.2 mcg and Cobalt levels are 69.3 mcg. Although my BHR looks perfect, the femoral neck has thinned a bit. Pain and clunking/grinding is back.

He recommended revision to a ceramic THR as I seem to be having a reaction to metal ions. I asked about Mini Hip and BMHR and he said that the only thing he could recommend is a THR. When he found out I don't have insurance he also offered to give me a discount. Under $5000 he said. He seemed very competent and although he has participated in many revisions he has only done 50 revisions on his own.

Anyway, gave me the prescription Dr. DeSmet recommended for a MRI with MARS Protocol. Costs about $2000 out of pocket so I will start shopping for insurance. In the meantime will send X-rays to Dr. Su, Dr. Bose, Dr. Gross and Dr. Mcminn.

Izumi 43 yrs old
LBHR Dr. DeSmet 2003

[B.I.L.L.]

Had an appointment with Dr Darwin Chen of Mount Sinai yesterday. He is not a resurfacing specialists but he is apparently an up and coming joint replacement/revision surgeon so I figured it couldn't hurt to hear what he had to say. My chromium levels are 84.2 mcg and Cobalt levels are 69.3 mcg. Although my BHR looks perfect, the femoral neck has thinned a bit. Pain and clunking/grinding is back.

He recommended revision to a ceramic THR as I seem to be having a reaction to metal ions. I asked about Mini Hip and BMHR and he said that the only thing he could recommend is a THR. When he found out I don't have insurance he also offered to give me a discount. Under $5000 he said. He seemed very competent and although he has participated in many revisions he has only done 50 revisions on his own.

Anyway, gave me the prescription Dr. DeSmet recommended for a MRI with MARS Protocol. Costs about $2000 out of pocket so I will start shopping for insurance. In the meantime will send X-rays to Dr. Su, Dr. Bose, Dr. Gross and Dr. Mcminn.

Izumi 43 yrs old
LBHR Dr. DeSmet 2003

Good luck Izumi. 5K for a revision sounds like the deal of the week compared to 2K for an MRI ?  Hope you can find some insurance that will cover it. Good luck & keep us posted