December 1, 2011 Metal Allergy
This week I went to see an allergist to get tested for the most common metal allergies. I’ve had skin reactions to earrings in the past so if I’m going to have a back full of rods and screws I want to be sure I’m not going to have a reaction that leaves me miserable and requires a second surgery for hardware removal. And it turns out I was right! I am severely allergic to nickel which is a common allergy among the metals and often surfaces from a reaction to cheap jewelry. This type of reaction is called contact dermatitis. It doesn’t guarantee you will have a reaction to implants too, but better safe than sorry!
In talking to different surgeons different types of instrumentation have been mentioned, including cobalt chromium, stainless steel, and titanium. All are alloys that contain other trace elements. According to Wikipedia, cobalt chromium and stainless steel usually contain some nickel, but titanium may not…
Titanium
Stainless Steel
Cobalt Chromium
I will of course confirm exactly what is in any instrumentation with my surgeon. And I don’t plan to base my surgeon decision on the type of instrumentation they usually use, but instead choose my surgeon, and then be sure they understand my allergy and are comfortable adjusting to a different type of instrumentation if necessary. Now that I know I have at least one metal allergy, I’m thinking I may even get tested for any additional metals in whatever instrumentation is recommended
On a side note, the allergist also tested me for all the common airborne allergies like pollen, dust, mold, and pets, and all were negative! This is what I was expecting but it helps confirm for me that all my head issues are migraine related, not allergy related. Although he made a point to say it doesn’t mean that I wouldn’t still react to pollution or other direct irritants in the air, and things did get worse about a year after moving to LA. One mystery solved, but many more remain…
- 13 comments
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livingtwisted 
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Cheree Tate
said
Have you considered seeing Dr Oheneba Boachie-Adjei, MD at the New York Hospital for Special Surgery? I have heard nothing but wonderful things about him. I would put him at the top of my list if I decided to have my scoliosis corrected, which I don’t plan on doing. I’ve been stable at 50 degrees since my mid-teens (diagnosed when I was 4), so I don’t plan on doing anything surgical. I was never braced, as I went from 20 to 50 degrees between 6 month check-ups as a teenager, was sent to another specialist (Dr Asher at Univ of KS) who said I was done growing and that my curve shouldn’t progress substantially. Somehow I seem to have even managed to avoid the 1 degree/year progression.
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livingtwisted
said
Wow, so interesting that you were diagnosed so young but most of the progression happened as a teen. I wonder if there are more JIS cases than we know that don’t get diagnosed until they are teens. Or is your case unique since like you said you haven’t progressed since. How old are you now?
I have wondered if I should be considering the top guys in the country regardless of location. But it’s not like my case is bad enough to warrant the top guys who only deal with difficult cases. And recovering in the comfort of home seems to put people at an advantage. I have to believe that in a major city like LA (that many people travel to for the scoli surgeons)I can find the right one for me. But at the same time, this is partly why I am seeking Dr. Weinstein’s opinion — a little perspective on reputations from a non-local.
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flerc
said
I would wait and use all the time I can to know about what that surgeons seems to know.
What if in few years and uncomparable best solution arise also to adults????
http://www.scoliosis.org/forum/showthread.php?12810-Dr.-Douglas-Kiester-discusses-MAGEC-Remote-Control-Spinal-Deformity-System
‘Because adult scoliosis works by yet another completely different mechanism which is now just beginning to be well understood by the more advanced spine surgeons, the MAGEC really doesn’t have any place in the treatment of adult scoliosis. This technology won’t work in that setting.’
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livingtwisted
said
You are always the optimist! I have been following that thread, but I see it differently. The MAGEC seems to be an alternative to bracing for growing children, much like VBS, although it guarantees the need for a 2nd surgery to remove the hardware once growth is complete, whereas the staples might never need to be removed (that is still to be seen). His theory about ligaments is just that — a theory. Its a nice one and I hope it is true, but it is yet unproven. And even if it does prove to be true, according to him ligaments turn to bone in adults so that information would not be useful to me anyway. He does imply that there is something else in the works for adults. But let’s think this through. MAGEC is not yet FDA approved in the US and who knows how long that will take. Let’s say all goes well and it gets approved and shows promise over time, then they move on to a similar solution for skeletally mature teens, and then finally adults. How many years from now is that? 10? 20? In my lifetime? I am done wishing and dreaming for a miracle cure FOR ME. I still have hope for the next generation, but I am now looking for real solutions for me.
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flerc
said
I believe the case of Magec is much different to the case of VBS. Now it seems that some surgeons are talking about a combination of methods that would be the cure of the scoliosis, not only about a new kind of brace. Holding the spine straight (and stretching it again) while doing some kind of movements seems to be the key for those surgeons. The way they are doing it is Magec (the only one possible?)
That ligament is a theory (it seems the same about turning in bone), but certainly is not important, I have never heard before surgeons talking about a reversible solution. If really Magec is absolutely reversible and works in kids, or adolescents still growing, surely they are having a greater knowledge and is very credible what Dr. Kiester says and may be true what he said about those Drs.. If they are really understanding the problem in adults, is probably they can arrive also to an aceptable and reversible solution…
Maybe nothing of that about Dr. Kiester is true, but if all is true I suppose that in no so many years should to be news for adults.. but of course may be not good news, who knows?..
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livingtwisted
said
I’m not sure I understand what you are saying. What exercise/movement is possible with MAGEC? It seems like your activity would have to be limited. What surgeons are talking about combining methods? What methods? I don’t know this for sure, but it sounded to me like the idea that ligaments turn to bone is actually a known fact true in most adults, not just those with scoliosis, and can probably be easily proven with cadavers. It sounds a lot like the calcification that happens with arthritis, its just your body’s way of protecting against wear and tear. What part of Dr. Kiester’s work do you think will apply to adults in the future?
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flerc
said
If I interpreted right what he said, the point is that Magec, although holding straight the spine, allow daily activities, at least some of them. I think he said that flexion is needed, so that is why a rigid brace is not useful at all.
Surgeons believing in Magec, certainly are believing (if they agree with Dr. Kiester) that maintaining the spine straight (method used by brace.. when is right used) and stretching tissues (as so much PT methods) would be the cure for scoliosis. It has not precedents!
Clearly much adults has a flexible spine. I believe that even with scoliosis. If since some age the ligament turn to bone in all scoliotic people, I suppose is something unknown. The proof with cadavers may be done, as so many others, that would prove so many mysteries around scoliosis. Do you believe this is happening with you? Do you have not a significant reduction being standing vs lying down? I only heard to Dr. Kiester saying that about ligament, but may be true.. in all scoliotic people regardless what they do? I don’t believe that. Surgery would cannot correct any adult curve if it would be true.
Kiester said that now some surgeons are understanding what happen with adults. As I said in the forum, Magec seems to be an inflexion point in surgeon’s point of view about scoliosis in kids. Who knows if the same would not occurs with adults?
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livingtwisted
said
I’m sorry, I guess I just don’t see how Magec is a cure any more than any of the other non fusion surgeries for kids. They are just treating the curve, but with a new technology that allows for growing rods without multiple surgeries. And no one has seen the results yet when you remove the rods after growth is complete, rather than fusing. It’s a fabulous advancement in treatment, but that’s it. Yes, I am straighter when I lie down, or better yet, use the inversion table. It gives me a nice waist and everything gets a bit longer. I’ve even learned to replicate that while sitting or standing using Schroth. But after seeing my bending x-rays and speaking to surgeons it is clear to me that there is a section of my spine right around the apex of the curve that is much less flexible than the rest. That is the area they will fuse and when they do it they actually chip away bone in order to gain enough flexibility to get a good correction. And that’s something they do in teens too. So there is something making the curve stiff that can’t be corrected even with just extreme direct force alone. It seems the only time this is not necessary is when growth remains so it can be gradually straightened over time instead.
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flerc
said
If all I have read in the forum is true. Magec is absolutely differents since is something reversible. The curve is corrected and nothing strange remains in the body. With other surgeries using roads, at least some kind of fusion remains for ever. So Magec would be really a cure.
Of course all is uncertain, but it seems that while flexibility exists and no so much vertebra deformation, nobody may say that is impossible, to reverse a curve in an adult. It seems to be a fact that the Spinecor may helps the spine to remains straight almost by herself. It seems that a rigid brace cannot do that.
Who knows if they could not discover what exactly is that not allow the vertebras to remains aligned when gravity force is pulling down and also a non so drastic way to correct it. .
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livingtwisted
said
Yes, you’re right that Magec is reversible. But so is VBS, which does not cause fusion. The staples can be removed at any time, they just haven’t because it hasn’t seemed necessary. I’m not sure why you think Spinecor can straighten an adult curve, and then keep that correction out of brace. What is that based on?
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flerc
said
I don’t know so much about VBS but I suppose that the difference should to be really very important. Otherwise important surgeons would not talk as they does about Magec and also members in the forum. I suppose that VBS is something as an internal brace, something better than an external brace. But Magec is conceptually different because combine 2 diffrerent principles (surgeons never did that before). Why do you think that there is nothing new with Magec? I don’t understand.
I said that Spinecor can straighten an adult curve, not that keep that correction when is removed.
Spinecor is not a brace, so is reasonable to expect a different outcome using it. Here http://www.scoliosis.org/forum/showthread.php?11423-Martha-Hawes-improves-her-scoliosis-w-exercise/page7 post #99, I explain what I refer to maintain the vertebras aligned. Suppose your curve decrease a 30% or 40% when you are lying down and your vertebaras are not so much deformed (may be seen in a MRI) so the Spinecor can maintain the vertebra alignment and therefore the reduction of the curve. But Spinecor would not do (like a brace) a force to hold the weight of the torso.. it seems that helps the bodie to do the same work that other tissue should to do to. It seems to be a mystery what tissue, what exactly does.. but it cannot be so difficult to know.
If medical community is really decided to arrive to a solution not so crude, gross and extremely invasive as fusion is, to maintain the vertebras aligned, maybe they discover what is exactly what is failing to allow that. maybe a very diferent surgery could does the work that failure tissues are not doing, who knows.
And who may says that combining the Spinecor (maintaining a significant reduction) with the right non surgical method, the scoliosis vicious cycle would not turn into a virtuous one?
They may do some things much more dificult when they want.
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livingtwisted
said
I’m sure we could go back and forth forever. I really hope you find what you are looking for, and that your daughter can have the best care out there.
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flerc
said
Ok, as you want. I don’t know why you believe we were going back and forth. Of course you may believe what you want about Magec, Spinecor or any non surgial method, is the same for me, I just only was trying to let you see, what I believed you were not interpreting right.. discussions of course has not sense for me here.
Thanks for your wishes.
I hope the best for you.