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briarrose
11-28-2008, 07:51 PM
I was wondering if anyone here has ever had to have their rods removed due to a metal allergy. There's a possibility that I'm allergic to mine. I've had this rash on my lower back since I was 3 weeks post-op. I attributed it to my brace at the time. My surgeon suggested I consult a dermatologist. I called in June and couldn't schedule an appointment until October. Then, the rash was brown so she took a biopsy. It came back as something with a really long name and she put me on minocycline (it wasn't an infection but was proven to help this type of rash). I went back 4 weeks later (last week) and a new rash had popped up on top of the other rash. She took another biopsy. I asked if she thought it was from my rods and she said it was definitely possible since the rash now goes all the way up my scar. The results came back as a type of dermatitis that could be a contact dermatitis or from the rods. So now I'm on a steroid cream. The problem is, I used a steroid cream back in July/August to try to get rid of the rash and it pretty much went away and then came back. I can't win. Would I have to have my hardware removed if the rash is from the metal? One good thing though, the nerve pain in my leg has pretty much gone away.

Thanks in advance for any input.

Shell

txmarinemom
11-29-2008, 05:04 AM
Shell ...

Are your rods titanium or 316 SS? I think I read (I'll have to check) about 5% of the population has a nickel allergy aggravated by stainless steel ...

Here's a brief rundown, and I'll see what else I can find for you.

"Nickel is a ubiquitous trace element and it occurs in soil, water, air and of the biosphere. It is mostly used to manufacture stainless steel. Nickel is the commonest cause of metal allergy. Nickel allergy is a chronic and recurring skin problem; females are affected more commonly than males. Nickel allergy may develop at any age. Once developed, it tends to persist life-long. "

I hate to hear you're having problems!

Pam

txmarinemom
11-29-2008, 05:32 AM
Er ... I may have been off with 5% (almost sure I saw that somewhere ... Dave Wolpert, why am I thinking it was in your book? It's in my car, or I'd go check - LOL).

Shell, while this article (http://www.baylorhealth.edu/proceedings/17_2/17_2_Abramovits.pdf)deals primarily with contact dermatitis from jewelry, it makes a brief mention of a Harrington rod (as related to a cobalt allergy), it has some interesting info, including:

"In their review of several European studies from 1972 to 1990, Reitschel and Fowler reported nickel allergy as the most common metal allergy, with a prevalence ranging from 7.3% to 17.4%."

Interestingly, the SECOND most common allergy is to cobalt, and Vitallium rods (like mine) are a proprietary CoCrMo alloy ... about 60% cobalt. The prevalence of allergy to cobalt is much lower, though ... with a median of slightly over 6%.

They state:

"Cobalt allergy is frequently related to nickel allergy, as both metals are often found together in costume jewelry and other metal-plated objects. It has even been proposed that nickel allergy may predispose one to cobalt allergy."

I'll keep digging and find some more instrumentation related stuff. And, yeah ... I know I'm making the assumption you have 316 SS rods. While it's probably possible, I've never read of titanium allergy. I have heard of allergies to Nitinol (NiTi ... the nickel/titanium memory metal used in vertebral stapling), but again, it's the nickel that triggers the allergy.

Back to the trenches ...

Pam

briarrose
11-29-2008, 08:54 AM
Hi Pam,

Thanks so much for taking the time to research this. One of my rods is commercially pure titanium and the other is a titanium alloy. I believe the screws are the alloy as well. The alloy contains a trace amount of nickel, but I'm not sure what the percentage is. I'm allergic to nickel and I had told my surgeon this ahead of time. He had me tape small pieces of each rod to my skin and I didn't have a reaction from the metal, just from the tape. I know titanium allergies are really rare but they do happen. It wouldn't surprise me if I was allergic to it because I'm allergic to so many other things (soaps, laundry detergent, lotions, deodorant, jewelry, etc.) Titanium is supposedly biologically inert. The rash could still be from the brace I suppose, except that it seems to run all the way up my scar. Is your scar still red and scaly? Maybe I just need a few days of prednisone to get rid of the rash. It's actually a lot better now since I've been using the steroid cream, but like I said, this has happened before. Thanks again for your help!

Shell

txmarinemom
11-29-2008, 09:28 AM
... One of my rods is commercially pure titanium and the other is a titanium alloy. I believe the screws are the alloy as well. The alloy contains a trace amount of nickel, but I'm not sure what the percentage is. I'm allergic to nickel and I had told my surgeon this ahead of time. He had me tape small pieces of each rod to my skin and I didn't have a reaction from the metal, just from the tape. I know titanium allergies are really rare but they do happen. It wouldn't surprise me if I was allergic to it because I'm allergic to so many other things (soaps, laundry detergent, lotions, deodorant, jewelry, etc.) ...

Interesting how he had you tape pieces of the rod to you ... now *there's* a visual - LOL!

I wonder why he'd put any nickel inside you, knowing you had an allergy: Even though you didn't react to the small pieces, it stands to reason particulate shedding would be greater on the full sized rods. That'd be a bummer if you were just allergic to even pure titanium ... ugh.

Just thinking here ...

Could it be something other than the rods? Maybe internal stitches? I mention that because my body won't dissolve the dissolvable one (it just spits them out ... practically whole), and it tries to expel even the blue PDS non-dissolvable ones. Apparently this surgery was the first time I'd ever had those: I'm probably going to have to go back in as a day surgery and have 4 of them cut out/clipped so they'll go back under the skin. I wonder if the sutures contain something (latex?) that's bothering you ...

If the rash is coming and going, hopefully it can be controlled with meds (although prednisone isn't what anyone would consider fun :()


... Is your scar still red and scaly?

No, and this far out from surgery, yours shouldn't be either. Wouldn't you think the dermatitis is to blame for that?

briarrose
11-29-2008, 10:10 AM
Interesting how he had you tape pieces of the rod to you ... now *there's* a visual - LOL!

I wonder why he'd put any nickel inside you, knowing you had an allergy: Even though you didn't react to the small pieces, it stands to reason particulate shedding would be greater on the full sized rods. That'd be a bummer if you were just allergic to even pure titanium ... ugh.

Yeah, it kind of confused me as to why he used to an alloy. He said if I did have a reaction from it, it would be really easy to replace. But who wants to go through that? I should have asked more questions about it or tried to convince him the pure titanium was a better idea. He's never had anyone have an allergic reaction to their metal before.



Could it be something other than the rods? Maybe internal stitches? I mention that because my body won't dissolve the dissolvable one (it just spits them out ... practically whole), and it tries to expel even the blue PDS non-dissolvable ones. Apparently this surgery was the first time I'd ever had those: I'm probably going to have to go back in as a day surgery and have 4 of them cut out/clipped so they'll go back under the skin. I wonder if the sutures contain something (latex?) that's bothering you ...

That must be annoying to have those stitches still in you. That will be nice to have them removed. Do they itch? I didn't have any stitches. My surgeon used some sort of adhesive, but that's still a really good point. I may be allergic to the adhesive. I have a love/hate relationship with predinisone. It has saved me so many times with all of my asthma problems but the side effects are horrible. I'd be willing to use it to get rid of this rash though. It's so itchy.


No, and this far out from surgery, yours shouldn't be either. Wouldn't you think the dermatitis is to blame for that?

I figured the dermatitis was to blame for the red and scaly scar. I was just hoping it was normal. I pulled so much scaly skin off of it yesterday. It was gross!

I'm so glad you mentioned the allergy from the stitches or in my case the adhesive. That would be much easier to treat than if I was allergic to the metal.

Thanks for your always helpful responses.

Shell

LindaRacine
11-29-2008, 12:06 PM
Hi Shell...

I know someone who had a severe allergic reaction to her SS rods, which had to be removed. Before her surgery to place titanium implants, she went through testing to see if she was sensitive to that metal as well. She doesn't remember what the tests were. She had her second surgery at UCSF, so I would think a university hospital system might be your best bet.

I can't imagine how annoying it must be. Good luck!

Regards,
Linda

txmarinemom
11-29-2008, 12:43 PM
... He said if I did have a reaction from it, it would be really easy to replace. But who wants to go through that?

Doh! "Really easy to replace" for *whom*? Him? Jeez.


... That must be annoying to have those stitches still in you. That will be nice to have them removed. Do they itch?

No, they don't itch. It's more a vanity issue with 3 of the 4 ... they look like pimples except you can see a blue spot in the middle of them from the stupid blue stitch. There just isn't ~quite enough to grab with tweezers and clip. They're up between my shoulder blades; *theoretically*, they shouldn't bother me ... except I can't keep my hands off them - LOL ... because ... I ... know ... they're ... there. AGH!

I made the comment to my 19 year old the other day "These things are driving me nuts!", to which she oh-so-kindly reassured me "Oh ... they REALLY would if you could see them, Mom.".

Thanks, kiddo!

I've been scrubbing the area with a salicylic scrub to encourage the skin to shed (where *maybe* they'll finally poke through), but no cigar. Maybe dermabrasion would do the trick, but the procedure would be almost certainly be considered cosmetic by my insurance.

The 4th one is a huge annoyance. It's riiiiiight under the skin at the L1 attachment point, and that one is just in a bad spot. About every 3-4 days, it gets irritated enough it'll swell. It seems to hit every chair I sit in (including my car), and occasionally produces lil' electric shock-like pain if I rub across it just so. If I had to guess, I'd say jumping and yelping are not good while driving.


... I didn't have any stitches. My surgeon used some sort of adhesive, but that's still a really good point. I may be allergic to the adhesive.

Sounds like Dermabond, Indermil or some sort of cyanoacrylate tissue adhesive. With all your documented allergies, I'm sort of surprised he used it (especially when you reacted to the TAPE when he tested you for metal allergies!).

Cyanoacrylate allergies are fairly rare, but they do happen (http://books.google.com/books?id=ZrclHh9Ep7AC&pg=PA567&lpg=PA567&dq=Cyanoacrylate+%2Bmedical+%2Ballergy&source=web&ots=f_hKow5ZaN&sig=zpe5hYm6NkOdo3rAr6L-_TBbR0U&hl=en&sa=X&oi=book_result&resnum=6&ct=result#PPA567,M1).

These tissue adhesives are biodegradable, but I have no idea how long it takes for them to break down. I agree it would be great if glue was causing your issues vs. the rods - as *eventually* it should clear out of your system.

I know you said you didn't have stitches, but you might want to ask about that again. Dermal glue isn't used without internal sutures. Tissue adhesive alone wouldn't hold an incision like ours together.

Out of curiousity, what type of graft material did they use for you? I've read where some people have delayed hypersensitivity reaction to allograft. No clue on the ramifications of that ... I guess the worst case would be a graft vs. host situation, but the cases I've read of weren't that severe. Just something else to ask (like you don't have enough questions!).

Hang in there, hon ... they'll finally get you straightened out from being straightened out ;-).

briarrose
11-30-2008, 09:35 AM
Hi Linda,
Thanks for your response. What kind of reaction did the person you know have to the metal? If the rash comes back after this steroid treatment, I'd like to have that metal testing done. I looked online and could only find MELISA and I'm not sure how legit that is. I don't think it's covered by insurance either. There are a number of university hospitals in Philly so I'll look into those if and when the time comes. Thanks for mentioning the university hospitals. I wouldn't have thought of them otherwise.


Doh! "Really easy to replace" for *whom*? Him? Jeez.

I just remembered the other reasons why he used the 2 different rods. He said he gets a better correction with the pure titanium and a better fusion with the titanium alloy.

I hope you don't have to go into surgery to have the stitches removed. Salicyclic acid is a good idea. Do you have any Retin-A? That is really good at shedding layers of skin. Maybe even a pumice stone? Could you even go to a dermatologist and have them numb the area and pull them out? They would drive me nuts. I'd constantly be trying to get them out too.

Thanks for the info on cyanoacrylate and the other adhesives. I'll have to look into them more and ask my surgeon what exactly he used. I may have my dermatologist contact him. She'd be able to figure out the stuff better than I would.


Out of curiousity, what type of graft material did they use for you?

I know he took some bone from my hip (it still hurts) and used some allograft material. Would a hypersensitivity interfere with the fusion at all? I know my fusion is pretty solid at this point. It's a good point though and I will definitely ask about it if the rash comes back.

Thanks again for your help!

Shell

Karen Ocker
11-30-2008, 11:41 AM
Trying to guess without all the facts can be a waste of time. I second Linda Racine's suggestion to consult a physician in a university hospital. An allergist can do some blood tests to see whether an allergic process is occurring in your body.

Sutures which come out through the skin and have not dissolved or been removed at the appropriate time can be a "wick" for bacteria to enter the body.:eek:

txmarinemom
11-30-2008, 04:45 PM
Trying to guess without all the facts can be a waste of time. I second Linda Racine's suggestion to consult a physician in a university hospital. An allergist can do some blood tests to see whether an allergic process is occurring in your body.

Of course she should consult a physician (or several), and I just happened to have some time to waste on a rainy day yesterday (I willingly wasted mine, but certainly didn't set out to waste anyone else's who read it). In NO way was I trying to diagnose her: My intent was merely to generate more ideas of things to ask. She already knows there's at least one allergic reaction going on, and I think brainstorming like that helps (and it did, I think) to remind someone of all they were exposed to - and my reaction to both monocryl and PDS sutures prompted my input.

Shell seemed to need to bounce around ideas, so we did. I apologize if you found it useless or tiresome to read.


Sutures which come out through the skin and have not dissolved or been removed at the appropriate time can be a "wick" for bacteria to enter the body.:eek:

Yeah ... I know. That's why we've been watching them - especially with my history of MRSA. Hanson is well aware of them - and John, his PA, looked at them a few weeks ago when my Mom was in the hospital (she fell, and Hanson assumed the role of her admitting physician ... made my life 1000x easier in a really difficult situation).

With my "cootied past", trust me ... I'm not touching anything back there with ungloved hands (and barely then, except to see if I feel a "poke" where one's come through). My chances of reinfecting *myself* are higher than picking up a new strain - as I'm most likely still a carrier (literally my own worst enemy). Fighting MRSA for 2-1/2 months - scared to death my 21 year old VP shunt (at the time) - made me very "germ aware" ... and the precautions I take to prevent reinfection are close to OCD ;-). In all seriousness, I know you can't be careful enough.

I'd fully expect to see skin lesions before a systemic infection (only because that's been historically true for me), and I have a 30 day supply of Bactrim here at the house so I can start immediate treatment if one comes up. And, no... I'd NOT take ONE SINGLE Bactrim pill unless I couldn't get in to see my Infectious Disease doctor at Baylor immediately - and either he or Hanson told me to start a round. I have no desire to lessen my strain's susceptibility to Bactrim ... that and Vanco are all I have (Cipro would work, but I'm extremely allergic).

No one is particularly worried about them yet (they're not actually *through* the skin - just under it ... enough to see the blue), but yes ... they need to come out.

In the meantime, I keep them clean and as protected as possible. Insurance is paying at 100%, so I expect when I get back from my 2 weeks journey around CA and UT in mid-December, I'll be having them removed. Yay.

Regards,
Pam

debbei
11-30-2008, 06:10 PM
Pam,

I'm sorry to hear about those sutures of yours. I'll keep you in my thoughts and hope they can get removed without any problems.

LindaRacine
11-30-2008, 07:16 PM
Hi Shell...

I think her reaction was also a never ending rash. Her surgeon thought it was safe to remove her rods (although I think it had only been about 8 months). When she went back for x-rays 3 weeks after removal, her curves had returned to their original degrees.

Regards,
Linda

discombobulated
11-30-2008, 08:22 PM
Shell [geez, I feel like I'm talking to myself :D]....so sorry you're having such problems. Sure hope your docs can put those overstuffed heads together & figure something out for you - preferably non-surgical!

--

Pam - you mentioned your VP shunt re. potential infection. I've never heard that my VP [22 yrs young] could be putting me at higher risk of infection?! Or is it "just" that any systemic infection may offer a way for infection to enter the brain via the tubing &/or settle stubbornly in the VP much like it might on the rods?? It's amazing how interconnected everything in the body is.....

Cheers.

txmarinemom
11-30-2008, 11:40 PM
Disc ... you have a VP shunt???

Mine is 29-1/2 years old now ... an old Holter system - never revised. Etiology unknown, placed for an unexplained, unprecented bout of communicating hydro ... spiked to 54 (5-7 times normal ... enough to cause total 6th cranial nerve palsy (my eyes stayed crossed for 6th months after shunting) and near total bilateral retinal hemorrhages - at age 10. ICP was *completely* normal before then, and I had no after effects. Miraculous.

I only learned the MRSA from my boob job put me at risk AFTER the fact ... and with your 22 year young (you're a congenital? Comminicating or non?)- and my 29-1/2 year young - we're fairly safe. We have encapsulated tubing ... a natural shunt of sorts. Even if ours crack, the scar tissue SHOULD hold the silastic safely.

We should talk more about this! Look at my x-rays and you can see mine curled in the peritoneum ...

You can also see what looks like a VERY distinct crack in the tubing in my neck ... which has been there who knows long - and is causing no issues. They have no clue whether I'm even still shunt dependent.

discombobulated
12-02-2008, 06:06 PM
Hi Pam,

Wow - you really went through the works at 10! I've not heard of such severe spontaneous hydro so early. Glad the VP's serving you well :)

I've got no idea what model I have, but I've only ever had one trouble with it (when I was a couple of months old), but that resolved after a few hours. I feel SO lucky because I know a lot of people who have myelomenigocele + congenital hydrocephalus who've had just so many problems with malfunctions/extra surgeries/infections/needing 2 shunts/learning disabilities from extended high pressure, etc..

As far as I know, the hydro that (often) comes with myelo/SB in general is actually considered acquired rather than congenital...but yes, I've had it since (before?) I was born. No idea whether it's comm/non. One of these days, I *really should* get a copy of my medical records - though I hate to think what those postage costs would be LOL :eek:

I completely missed your tubing on x-rays till now - I'm used to seeing what looks like mile curling around my abdo, lol. Apparently, my neurosurgeon said he'd given me enough to grow at least to a 6 foot 100 yr old without the need for extension surgeries :D I'd never even considered the tubing splitting - but good to hear that shouldn't be a problem! I do seem to have scar tissue holding it tightly on my collarbone so I can't stretch my neck right up properly (doesn't help with scoli-related neck probs!). Might get that attended to next year, been meaning to.

Anyhow, much thanks for reassurance that we're fairly safe. I don't need any more ways to get infection - even my dentist [check for loose teeth or other probs, pre-op] yesterday said, "glad you're teeth are clean. Keep that up well. You know, not brushing properly allows the bacteria to multiply & it is possible for them to enter the body & migrate. You probably don't want them getting aboard your new metal." Oh, REALLY?! :eek: Thanks, doc.

--


Shell, I'm so sorry to have momentarily side-tracked your thread :o I hope you can get things sorted soon. Keep us posted - take care.

briarrose
12-02-2008, 09:48 PM
Shell, I'm so sorry to have momentarily side-tracked your thread :o I hope you can get things sorted soon. Keep us posted - take care.

Not a problem. I've been so busy studying for end of the semester tests that I haven't had a chance to respond. I appreciate your response and will let you know what ends up happening.

Linda - That is exactly why I do not want my rods removed. 8 months does seem kind of early.

Pam - You were a huge help to me. And yes, I did need to bounce ideas off of someone. It helped me gather all my thoughts and figure out what to do next. Thanks again.

Karen - You're response made me realize I need to act sooner rather than waiting around for the rash to come back. As soon as this semester is over, I'm going to contact my surgeon and see if he can recommend an allergist to test for metal allergies.

I'll keep everyone posted on what happens next. Thanks!

Shell

Karen Ocker
03-19-2009, 05:18 PM
This is interesting with a case history of a metal hip implant sensitivity but may apply to scoliosis implants.


http://emedicine.medscape.com/article/1230696-overview?src=emed_whatnew_nl_0#Implants