Paul Pierce: Knee Drained, out for a week or 2

[chakdaddy]

Chakdaddy: 1) Post-traumatic septic joints are not uncommon. 2) Paul is a healthy young dude in prime physical condition. A few hours before the onset of his illness, he scored 19 points in Q4 in a classic display of Truth clutchness. That does not describe a man with a severe ongoing systemic bacterial infection which seeded his knee. No way.

Thanks, I'm a radiologist and it's been awhile since I was an intern
I was thinking more on the lines of transient bacteremia, maybe he had dental work or something. I didn't really realize that post-traumatic septic joints were that common.

Not really applicable to Pierce, but I always wonder what the MRI looks like on a guy like Tim Hardaway where they say he is bone on bone, etc - how that looks in comparison to a usual ugly arthritic knee; how the injuries/degen that hinder athletes compare to day to day civilian stuff. Do they play through minor things that would bother lesser people? Or do they need to perform at such a high level that they are affected by minor things that non-athletes wouldn't care about?

[BadWolf]

Infected joints are not treated with just draining them. They require a surgery, arthroscopic, usually more then one, so I'm sure it was something else, probably bursitis, which might linger, but is usually not causing much problems. Not sure why you'd think it's mrsa, I'd say that's very unlikely.

[exculpatory]

Chakdaddy: 1) Post-traumatic septic joints are not uncommon. 2) Paul is a healthy young dude in prime physical condition. A few hours before the onset of his illness, he scored 19 points in Q4 in a classic display of Truth clutchness. That does not describe a man with a severe ongoing systemic bacterial infection which seeded his knee. No way.

Thanks, I'm a radiologist and it's been awhile since I was an intern
I was thinking more on the lines of transient bacteremia, maybe he had dental work or something. I didn't really realize that post-traumatic septic joints were that common.

Not really applicable to Pierce, but I always wonder what the MRI looks like on a guy like Tim Hardaway where they say he is bone on bone, etc - how that looks in comparison to a usual ugly arthritic knee; how the injuries/degen that hinder athletes compare to day to day civilian stuff. Do they play through minor things that would bother lesser people? Or do they need to perform at such a high level that they are affected by minor things that non-athletes wouldn't care about?

Chak:

1) I find it funny that we are now having a "medical" chat contributed to by docs who also happen to be Celtic fanatics! LOL
2) You make a valid point (ahem, LOL, especially as a radiologist) about transient bacteremia
related to a relatively minor procedure such as dental work seeding a joint - perhaps a previously damaged joint predisposed to systemic seeding, e.g. It is well known amongst non-athletes that joints severely damaged by RA are predisposed to secondary bacterial infection.
3) Your last point is intriguing. I think that pro athletes "play thru" injuries and illnesses that would knock people like you and me on our arses.

Merry Xmas

Ex

[exculpatory]

Infected joints are not treated with just draining them. They require a surgery, arthroscopic, usually more then one, so I'm sure it was something else, probably bursitis, which might linger, but is usually not causing much problems. Not sure why you'd think it's mrsa, I'd say that's very unlikely.

Wolf:

1) Are you an orthopod, rheum or ID?
2) I brought up septic bursitis also - but that seems to be inconsistent with the fact that they apparently scoped the joint per se, drained the pus, and then irrigated the joint with an aqueous antibiotic formulation + saline.
3) I brought up MRSA because Staph Aureus is the most likely pathogen in a post-traumatic septic joint (although I used to see plenty of gonococcal monoarthritis as a young internal medicine resident many years ago), and COMMUNITY-ACQUIRED MRSA has become incredibly more prevalent during the last decade. Most MRSA infections require Vanc (an effective but nephrotoxic drug that I personally dislike). To make things worse, unfortunately, there are now more and more reports of VRSA (vancomycin-resistant staph aureus) because of legit overuse/misuse of vanc and disgustingly adaptive/intelligent staph aureus bacteria!

In conclusion, let's all hope that it was not a flagrant septic arthritis and that it was something like septic bursitis, and that he can play as early as the middle of next week.

The Truth is the "man" on this team, and we need him back as soon as possible!

I hope KG, RA, and Ray, are exceptionally awesome today, and we kick their asses without the Truth!

Go Green and Paul Pierce FOREVER!!!!!

Merry Xmas.

Ex

[exculpatory]

I am now hopeful that RR, KG, Ray, and Perk etc can get us Ws vs. Clips and GS, and that Paul can rejoin us in Px next Wed - when we really will need him!

[exculpatory]

Hi guys,

I have not been online because I am now on page 200 of a huge medical manuscript that I have been writing. I have been working on it literally 18 hours a day every single day including weekends and holidays for the last couple months. My deadline is Wed-Thurs - so when I get it done, I can return to life. I cannot frigging wait.

I was just shutting my puter down for the night but decided to read tomorrow's Herald to relax.

Read the Truth update article. I do not know how to put a link in, but would love to learn.

Paul did have TRUE SEPTIC ARTHRITIS, not bursitis or osteoarthritis with sterile flud. A 40,000 white blood cell count in joint fluid = SEPTIC ARTHRITIS = the real deal. That is the kind of infection must be treated rapidly and properly or the infection rapidly totally destroys the joint. And I bet you again that it was MRSA as the infecting organism. Read what I wrote at the beginning of this old thread if you want to read more medical details.

He still has limited motion in his knee, has had it drained multiple times, and I am sure he has been popped full of antibiotics - at first intravenously and now orally.

I am afraid that he will not play for at least another week.

But at least he is on the mend.

Ex

[Jammer]

Chakdaddy: 1) Post-traumatic septic joints are not uncommon. 2) Paul is a healthy young dude in prime physical condition. A few hours before the onset of his illness, he scored 19 points in Q4 in a classic display of Truth clutchness. That does not describe a man with a severe ongoing systemic bacterial infection which seeded his knee. No way.

Thanks, I'm a radiologist and ... how the injuries/degen that hinder athletes compare to day to day civilian stuff. Do they play through minor things that would bother lesser people? Or do they need to perform at such a high level that they are affected by minor things that non-athletes wouldn't care about?

[exculpatory]

Chakdaddy: 1) Post-traumatic septic joints are not uncommon. 2) Paul is a healthy young dude in prime physical condition. A few hours before the onset of his illness, he scored 19 points in Q4 in a classic display of Truth clutchness. That does not describe a man with a severe ongoing systemic bacterial infection which seeded his knee. No way.

Thanks, I'm a radiologist and ... how the injuries/degen that hinder athletes compare to day to day civilian stuff. Do they play through minor things that would bother lesser people? Or do they need to perform at such a high level that they are affected by minor things that non-athletes wouldn't care about?

Hey Jam

Unfortunately, my long distance diagnosis was correct. He had the real thing. If they had not acted so quickly with the combo of drainage 2-3 times and antibiotics intravenously, it would not simply have been a matter of losing Paul a long time - his entire knee joint potentially could have been wiped requring a knee REPLACEMENT. I still think the organism was MRSA, but could have been multiple other bacteria if it emanated from an infected cut on his toe and spread to his knee either via lymphatics or transient bacteremia.

I would not be surprised if he misses all 3 games this week. But he is one tough ****. Remember the time Amare knocked out his 2 front teeth on a Wed, he had 12 hours of oral surgery on a Thursday, and the next day he scores 30 points?

HNY Jam

[SichtingLives]

If it is treated properly and he recovers, what are the odds that this could have any lasting or reoccuring effect on his knee? Or is it something he shouldn't have to worry about again?

[exculpatory]

Very astute question, Dunk. Very astute.

If this was an endocrinology or electrolyte question, I could give you a maximally definitive answer.

Once I finish this paper and meet my deadline which has now been extended to Monday 1/11, I will either research that myself on Pub Med, or, even easier, ask a rheumatologist or orthopedist or infectious disease friend of mine, and get you a definitive answer. I honestly do not know the long-term ramifications of having had a properly treated septic joint. My gut tells me that his prognosis is very good as an otherwise healthy young man. But I do not want to commit to a definitive answer today.

HNY

EX

[sam_I_am]

It is so hard to read between the lines to know what is really going on. 40000 white cells in fluid could still be aseptic reactive arthitis as he is also said to have skin infection after cutting his foot. I still find it hard to believe that if he had septic joint he would not be jumping and running as good as he is already unless this was a major major save on his doctors part. Only answer is if his joint fluid culture shows bacterial growth.

Anyway, Pierce is a marvel. Returning quickly from septic arthritis may be nearly as impressive as his quick return from stab wounds to the chest.

[exculpatory]

It is so hard to read between the lines to know what is really going on. 40,000 white cells in joint fluid could still be aseptic reactive arthitis as he is also said to have had a skin infection after cutting his foot. I still find it hard to believe that if he had a septic joint, he would be jumping and running as well as he is already unless this was a major major save on his doctors' part. Only answer is if his joint fluid culture shows bacterial growth (I would bet you dollars to donuts that it grew MRSA, methicillin-sensitive staph aureus, strep, an anerobe, or possibly a gram negative if the source was his foot. And that he was initially empirically treated with broad spectrum antibiotic coverage, until they cultered the organism and determined sensitivities)

Anyway, Pierce is a marvel. Returning quickly from septic arthritis may be nearly as impressive as his quick return from almost lethal stab wounds to the chest complicated by a pneumothorax. (You left out the time he scored 30 points the day after 12 hours of oral surgery to replace the 2 front teeth Amare knocked out the day before that - LOL.)

Sam buddy!!! LTNS!!! (Sam is my long-time friend from this board and one of the few of us who really and truly understands how **** magnificent the Truth is, and how underestimated and taken for granted he is - even by some Celtic fans. Sam and I go back to the days of that buffoon Curmudgeon who wanted to trade Paul for frigging Darius Miles or a bag of peanuts. LOL.)

Listen to me, Sam. I am an endocrinologist, but I have run an Internal Medicine Residency Program, and I know a great deal about the other internal medicine subspecialties including rheumatology.

Answer = MAJOR MAJOR SAVE AND ONE VERY VERY TOUGH DUDE.
40K WBC in joint fluid = SEPSIS (only alternative which can cause a joint WBC that high does NOT apply to Paul = gouty arthritis or pseudogout). A sterile reactive arthritis (e.g., associated with Reiter's syndrome or bacterial dysentery due to salmonella/shigella/yersinia) NEVER does that.
His skin infection in the ipsilateral foot seeded the joint via lymphatics draining his foot, or, less likely, via transient bacteremia.
Had the foot infection flourished and produced septic cellulitis/fasciitis/lympangiitis, and thence sustained bactermia and generalized sepsis (which it did NOT), he would have been profoundly systemically ill and at risk for adult respiratory distress syndrome (ARDS), and he would have been hospitalized, perhaps even in the ICU. They have been close-mouthed, but WE KNOW THAT SCENARIO DID NOT OCCUR.

Sam, please stay in touch. I can be reached at Atorvastat@aol.com.

EX