With less than 2 days until D-Day, I’ve got Europe’s “Final Countdown” running through my head. Of course, Final Countdown brings mixed memories. The song reminds me of Arrested Development’s Gob performing magic tricks and making a high school mix tape – Final Countdown was the first song on Side A of the CasEtri. It’s a tough call which is more fitting of a knee surgery countdown.
I met with my OS this morning to go over the last-minute paperwork. Most of it was routine – hearing the standard admonition not to eat or drink after midnight; receiving a prescription for powerful narcotics; and signing a waiver acknowledging all the bad possible outcomes (always a personal favorite for lawyer-patients). I did, however, learn something new. My surgeon’s starting his own practice in 2009. He spent the first 20 or so years on his own before joining the current practice a number of years ago. He brought his own staff with him then, and all of them are leaving with him now. His new practice opens January 1st.
My first thought – Oh, shit. Will he still be on my insurance plan? This doesn’t impact the Dec. 31st surgery, but might impact the dozens of follow-up appointments. EOBs full of evil out-of-network charges instantly flashed before my eyes. But Turgeon says the insurance won’t change. He picked all of his insurance carriers and medical supply contacts prior to joining his current practice, and he’ll keep them when he opens his own office. At this point, BCBS still lists him as a “preferred provider” for 2009, but it also still shows his old address. As my father wisely counsels, it’s beyond my control so there’s no need to worry right now.
After leaving the doctor’s office, it was time to pick up some last-minute items. We went to Dougherty’s Pharmacy, which, fittingly, resembles a 1950’s Mom & Pop Dime Store. In fact, I think most of the shoppers in the store today could’ve been customers in the 50’s, too. Except for the cashier, Christina and I were the only folks younger than 350 years old. All of the store signs were written in 48-point font.
A tad bit embarrassed, I asked the cashier where the shower seats and, ahem, toiler seat risers were located. At first, I wanted to lie and tell him the items were for an elderly relative. No dice. I quickly gave myself away when I started “test-driving” the different toilet seat risers. I’m not kidding. I took a couple of mock poops before making my final selection.
The store offered 2 options: (1) the toilet seat shaped like a walker with a slender bowl-rim suspended in the middle, and (2) the oversized toilet cover that rises like a skyscraper 5 inches above the bowl. After hurriedly squatting back-and-forth between my toilet seat options like an antsy 4-year old, I settled on the oversized riser. Made by Nova, the heavily molded toilet seat provides luxurious comfort, as well as side handles that allow me to push off back to my feet. I consider it the Cadillac of raised toilet seats. I have a feeling I won’t want to give it up even after my knee heals. I know George Costanza wouldn’t. For my shower seat, I chose a basic white bench with a single red handle, completing our bathroom renovation. Unfortunately, Dougherty’s refused to throw in a free Driving Miss Daisy DVD.
Anyway, here's the bottom line:
Toilet seat riser -- $85.
Shower seat -- $55.
Geriatric purchase experience? Priceless.
Monday, December 29, 2008
Sunday, December 21, 2008
Rehab is kinda like pregnancy
No matter how much we empathize, husbands simply can’t grasp what their wives experience during pregnancy. Gaining 50 pounds? Perhaps. Craving bizarre food combos? Maybe. But it’s impossible for guys to understand what it feels like to have something kicking around inside our bellies. And no, that undercooked beef burrito we grabbed from Taco Bueno at 2am doesn’t count.
Rehab might be the closest we get. Both last about 1 year, and both are littered with time-stamped milestones, as patients are expected to reach certain targets at 8 weeks, 5 months, you name it. Of course, pregnancies chart the growth of a human being, like the formation of a baby’s lungs, while rehab tracks how many degrees a knee can bend. Subtle differences, to be sure.
At my last appointment, I received the ACI rehab protocol. Good lord. The Dallas Cowboys playbook isn’t this detailed. It breaks down my 52-week PT schedule into 4 broad “phases,” similar to pregnancy’s trimester approach. Um, my wife’s shaking her head right now. I think that’s her signal that the rehab-pregnancy comparison has gone too far. Time to stick with rehab.
Ok, the first part of the rehab is called, the “Protection Phase.” The goal is to protect the implanted cartilage cells, which rest precariously inside my knee like recently pored concrete. Most importantly, my knee must remain “non-weight bearing,” or NWB, during Phase 1.
As soon as I get home from surgery, rehab begins. I’m not kidding. There’s a rehab assignment for Day One. 6-8 hours after the surgery, I initiate Continuous Passive Motion (CPM) for 8-12 hours/day, something I’ll continue until my knee reaches a certain Range of Motion (ROM). Yes, I realize I’ve already used more acronyms than a CIA briefing. Hopefully I’ll use only 2-3 acronyms regularly. Most are fairly self-explanatory, but I’ll post an “Idiot’s Guide to ACI Acronyms,” just in case you need help.
For the first 6 weeks, my best friend is the CPM. The CPM is a motorized knee brace which mechanically bends my knee in slight increments. The automated movement helps cell growth, and also creates a smooth surface along the cartilage surface. I’m allowed to progress my ROM by 5-10 degrees/day, “as tolerated.” Wait, does this mean I have to stop the moment I yell out in pain? Can I scream twice? Can I chomp down on one of those horse bits to deflect the pain? My interpretation of “as tolerated” might be a little different than others. Anyway, I need to hit 120 degrees ROM by Week 6 before I graduate to Phase 2, which means I need to be able to bend the knee all the way backwards. When I’m not using the CPM, my knee remains locked in a brace at 0 degrees at all times, including during sleep. Because it’s my right knee, I can’t drive during Phase 1.
In my opinion, the rehab protocol omits critical tips, like, “If you wake up in extreme pain, pop 3 vicodin. Repeat every 15 minutes if pain persists,” and “Ring little bell when you can’t reach your book or laptop. If ignored, demand compliance from wife. When she tells you to fuck off, apologize, point to injured knee, and beg for sympathy.”
Some of the rehab is redundant. There are only so many ways to say, “Bend your knee a little bit further.” However, seeing the simple, incremental targets spread out over one year is finally driving home the difficult journey I’m about to embark on. Ok, that last sentence sounded really lame. Or like a contestant on The Bachelor. But this is definitely The. Most. Dramatic. Blog. Post. Ever. Well, at least until the next post. Stay tuned.
Rehab might be the closest we get. Both last about 1 year, and both are littered with time-stamped milestones, as patients are expected to reach certain targets at 8 weeks, 5 months, you name it. Of course, pregnancies chart the growth of a human being, like the formation of a baby’s lungs, while rehab tracks how many degrees a knee can bend. Subtle differences, to be sure.
At my last appointment, I received the ACI rehab protocol. Good lord. The Dallas Cowboys playbook isn’t this detailed. It breaks down my 52-week PT schedule into 4 broad “phases,” similar to pregnancy’s trimester approach. Um, my wife’s shaking her head right now. I think that’s her signal that the rehab-pregnancy comparison has gone too far. Time to stick with rehab.
Ok, the first part of the rehab is called, the “Protection Phase.” The goal is to protect the implanted cartilage cells, which rest precariously inside my knee like recently pored concrete. Most importantly, my knee must remain “non-weight bearing,” or NWB, during Phase 1.
As soon as I get home from surgery, rehab begins. I’m not kidding. There’s a rehab assignment for Day One. 6-8 hours after the surgery, I initiate Continuous Passive Motion (CPM) for 8-12 hours/day, something I’ll continue until my knee reaches a certain Range of Motion (ROM). Yes, I realize I’ve already used more acronyms than a CIA briefing. Hopefully I’ll use only 2-3 acronyms regularly. Most are fairly self-explanatory, but I’ll post an “Idiot’s Guide to ACI Acronyms,” just in case you need help.
For the first 6 weeks, my best friend is the CPM. The CPM is a motorized knee brace which mechanically bends my knee in slight increments. The automated movement helps cell growth, and also creates a smooth surface along the cartilage surface. I’m allowed to progress my ROM by 5-10 degrees/day, “as tolerated.” Wait, does this mean I have to stop the moment I yell out in pain? Can I scream twice? Can I chomp down on one of those horse bits to deflect the pain? My interpretation of “as tolerated” might be a little different than others. Anyway, I need to hit 120 degrees ROM by Week 6 before I graduate to Phase 2, which means I need to be able to bend the knee all the way backwards. When I’m not using the CPM, my knee remains locked in a brace at 0 degrees at all times, including during sleep. Because it’s my right knee, I can’t drive during Phase 1.
In my opinion, the rehab protocol omits critical tips, like, “If you wake up in extreme pain, pop 3 vicodin. Repeat every 15 minutes if pain persists,” and “Ring little bell when you can’t reach your book or laptop. If ignored, demand compliance from wife. When she tells you to fuck off, apologize, point to injured knee, and beg for sympathy.”
Some of the rehab is redundant. There are only so many ways to say, “Bend your knee a little bit further.” However, seeing the simple, incremental targets spread out over one year is finally driving home the difficult journey I’m about to embark on. Ok, that last sentence sounded really lame. Or like a contestant on The Bachelor. But this is definitely The. Most. Dramatic. Blog. Post. Ever. Well, at least until the next post. Stay tuned.
Friday, December 19, 2008
D-Day is approaching
The surgery date has been set – 12-31-08. Yup. New Year’s Eve. Or as Christina likes to say, “Happy Knee Year!”
People keep asking me how I feel about the upcoming surgery. Remember Clubber Lang’s prediction in Rocky 3? Pain, said Mr. T. Before this surgery, I think the time I was most scared was when a bunch of seniors at my fraternity forced me to eat 3 whole jalapenos sober without a chaser. That was my punishment for being the Problem Pledge. I think this surgery will hurt much worse, though the vicodin should take away some of the sting. In some ways, I feel like the kid who fucked up and knows that momma’s waiting at home to whoop his ass. It’s time to face the music.
Some might suggest I’m being a bit selfish by scheduling the surgery on New Year’s Eve. Well, those people would be right. I am extremely selfish. I plan to milk my upcoming incapacity like an industrious farmer after 4 Red Bulls. But I didn’t screw up any special New Year’s plans. We weren’t heading to some swanky ballroom to sip champagne at midnight while being showered with confetti. Nor did we plan on hitting any 4am raves at secret warehouses.
Long gone are the days of paying $40 cover charges to drink unlimited 8oz plastic cups of beer and wine. Honestly, after having kids our New Year’s became pretty lame. These days, we watch the ball drop in Times Square, consider that close enough, and call it a night. I’m lucky if I’m still awake for some New Year’s nookie. Frankly, this year’s New Year’s Eve won’t be too different. Well, except for the nookie. I can handle the pain, but not the lack of nookie. It’ll be like sophomore year in high school all over again. Only without the acne, thank god. Anyway, this year I’ll watch the festivities with my SUV-sized knee draped over some pillows, bitching that the rabbit ears are obstructing the view on the ancient 13” TV in our bedroom. Part of me, however, is secretly excited about this New Year’s. I’ll be armed with a bottle of vicodin and a truckload of Ryan Seacrest jokes. That’s pretty tough to top. I’m pretty confident I’ll be giggling at midnight.
The decision to schedule the surgery on New Year’s Eve was strictly a timing and monetary one. Because of the lengthy rehab, I wanted to schedule the surgery as soon as possible. December 31st happened to be the first day the cloned cartilage cells would be available. Luckily, the surgery center and Dr. Turgeon were also available that day. Actually, it’s pretty good timing for everybody involved. The OR staff gets to stuff their pockets with all the leftover narcotics from my surgery before heading out to their New Year’s cocktail parties. And for me, having the surgery on the 31st brings the added bonus of lowering my surgical bill. I’ve already incurred a large chunk of health expenses this year. This surgery will put me well over my maximum out-of-pocket exposure. On January 1, that number starts over, so by sneaking in the surgery on the last day of the year, I’m saving a few dollars. Not only am I devishly handsome and gimpy, but I’m practical. It’s a wonderful combination that Christina can’t resist.
People keep asking me how I feel about the upcoming surgery. Remember Clubber Lang’s prediction in Rocky 3? Pain, said Mr. T. Before this surgery, I think the time I was most scared was when a bunch of seniors at my fraternity forced me to eat 3 whole jalapenos sober without a chaser. That was my punishment for being the Problem Pledge. I think this surgery will hurt much worse, though the vicodin should take away some of the sting. In some ways, I feel like the kid who fucked up and knows that momma’s waiting at home to whoop his ass. It’s time to face the music.
Some might suggest I’m being a bit selfish by scheduling the surgery on New Year’s Eve. Well, those people would be right. I am extremely selfish. I plan to milk my upcoming incapacity like an industrious farmer after 4 Red Bulls. But I didn’t screw up any special New Year’s plans. We weren’t heading to some swanky ballroom to sip champagne at midnight while being showered with confetti. Nor did we plan on hitting any 4am raves at secret warehouses.
Long gone are the days of paying $40 cover charges to drink unlimited 8oz plastic cups of beer and wine. Honestly, after having kids our New Year’s became pretty lame. These days, we watch the ball drop in Times Square, consider that close enough, and call it a night. I’m lucky if I’m still awake for some New Year’s nookie. Frankly, this year’s New Year’s Eve won’t be too different. Well, except for the nookie. I can handle the pain, but not the lack of nookie. It’ll be like sophomore year in high school all over again. Only without the acne, thank god. Anyway, this year I’ll watch the festivities with my SUV-sized knee draped over some pillows, bitching that the rabbit ears are obstructing the view on the ancient 13” TV in our bedroom. Part of me, however, is secretly excited about this New Year’s. I’ll be armed with a bottle of vicodin and a truckload of Ryan Seacrest jokes. That’s pretty tough to top. I’m pretty confident I’ll be giggling at midnight.
The decision to schedule the surgery on New Year’s Eve was strictly a timing and monetary one. Because of the lengthy rehab, I wanted to schedule the surgery as soon as possible. December 31st happened to be the first day the cloned cartilage cells would be available. Luckily, the surgery center and Dr. Turgeon were also available that day. Actually, it’s pretty good timing for everybody involved. The OR staff gets to stuff their pockets with all the leftover narcotics from my surgery before heading out to their New Year’s cocktail parties. And for me, having the surgery on the 31st brings the added bonus of lowering my surgical bill. I’ve already incurred a large chunk of health expenses this year. This surgery will put me well over my maximum out-of-pocket exposure. On January 1, that number starts over, so by sneaking in the surgery on the last day of the year, I’m saving a few dollars. Not only am I devishly handsome and gimpy, but I’m practical. It’s a wonderful combination that Christina can’t resist.
Sunday, December 14, 2008
The DeNiro Effect
Robert DeNiro is probably my favorite actor. Swayze and Van Damme are right up there, too. Unlike those other guys, however, DeNiro’s IMDB is full of quality movies. No matter the role, he’s always a bad ass, whether it’s a mob movie (Goodfellas, Godfather or Casino), action flick (Heat), or just a plain, great movie (Sleepers, Midnight Run or Meet the Parents).
Now, what does DeNiro have to do with my upcoming knee surgery? Well, DeNiro was a master at transforming his body for movies roles, and I’m about to experience my own transformation, though mine will be unintentional.
DeNiro’s greatest performance, I think, was in Raging Bull, the story about boxer Jake LaMotta which earned DeNiro an Oscar. In Raging Bull, DeNiro hit both ends of the weight spectrum, getting shredded to play the heavyweight champ in his prime, and then gaining 60 pounds to play the elderly Jake LaMotta.
I’m in the midst of my own roller coaster weight gain/loss. Thankfully, my swings aren’t as extreme as DeNiro’s. At least not yet. If I gained 60 pounds, I might be eligible for The Biggest Loser. I couldn’t handle that. Something about really large people in skivvies standing on oversized scales seems wrong. Or Dutch. That might be normal for them.
While weight gain might seem a bit trivial -- or vain -- considering the severity of the surgery, I’m legitimately worried about looking like a 70-year old Jake LaMotta next summer. I realize that once my knee heals I should be able to lose any weight gained, but for some reason I’m almost as worried about how fat I’m gonna get from inactivity as I am about the grueling rehab process. I don’t know why I feel that way. I just do. And yes, I recognize I sound like a 15-year old girl. But my blog readers deserve nothing less than my un-filtered emotions.
Since I re-injured my knee this summer, my weight’s swung 5-10 lbs several times. After first injuring my knee, I couldn’t exercise for a few weeks because the back of my knee swelled up like Barry Bonds’ noggin. Add 5 pounds. After the swelling subsided, I decided to have surgery, but postponed it for a few months. I decided to get in the best possible shape pre-surgery. Plus, I wanted to get my body “bikini-ready” for my October vacation to Maui. I realized most beachgoers would be staring at my wife, not me, but I still have pride. Besides, you never know when the paparazzi might be lurking.
Over the next 2 months, I ate extremely healthy. You know what? Eating right is 100x more important for getting in shape than lifting weights or doing cardio. Had I known that I never would’ve eaten all those chicken patties back in high school. I single-handedly kept Tyson’s in business. Anyway, 12 pounds disappeared. I didn’t win any bodybuilding competitions, but I trimmed up considerably. I joked that instead of 6-pack abs, I had a 2-pack. I’m not going to lie: In Maui, women swooned when I took off my shirt. I kept waiting for the shirtless beach photos to show up in The Enquirer, but no such luck.
I came back from vacation feeling bloated; that happens when you gorge on nothing but burgers, beer and ice cream for 1 week. Add 5 pounds. Unfortunately, I wasn’t able to drop those pounds right away. After we returned from Maui, I went out of town twice, and my eating and workout schedule always gets jacked up when I travel. And then it was time for Part One of the ACI surgery.
Arthroscopic surgery really isn’t that big of a deal. After all, pro football players routinely play a week or 2 after getting scoped. But I’m not a pro athlete. Frankly, I’m not even a true professional. I mean, I work for the government. Anyway, I hardly exercised for the next 3 weeks while my knee healed. Add 5 more pounds. But the great thing about eating right is that once you’ve done it, your body quickly recaptures the virtues of eating veggies and grilled chicken. It’s like riding a bike. After a week or 2 of eating right and exercising again, I’m back to my Maui weight, though my abs lost half of my 2-pack. I guess I’m sporting a 1-pack now.
I’ve got 3 or 4 weeks to reclaim that 1-pack. But I’m not stopping there. In fact, I plan on carrying over this attitude to rehab, and there’s nothing more hardcore than showing up for PT with your face painted. If I fail, I might be the first contestant on The Biggest Loser who’s “before” picture was half-red, half-black.
Now, what does DeNiro have to do with my upcoming knee surgery? Well, DeNiro was a master at transforming his body for movies roles, and I’m about to experience my own transformation, though mine will be unintentional.
DeNiro’s greatest performance, I think, was in Raging Bull, the story about boxer Jake LaMotta which earned DeNiro an Oscar. In Raging Bull, DeNiro hit both ends of the weight spectrum, getting shredded to play the heavyweight champ in his prime, and then gaining 60 pounds to play the elderly Jake LaMotta.
I’m in the midst of my own roller coaster weight gain/loss. Thankfully, my swings aren’t as extreme as DeNiro’s. At least not yet. If I gained 60 pounds, I might be eligible for The Biggest Loser. I couldn’t handle that. Something about really large people in skivvies standing on oversized scales seems wrong. Or Dutch. That might be normal for them.
While weight gain might seem a bit trivial -- or vain -- considering the severity of the surgery, I’m legitimately worried about looking like a 70-year old Jake LaMotta next summer. I realize that once my knee heals I should be able to lose any weight gained, but for some reason I’m almost as worried about how fat I’m gonna get from inactivity as I am about the grueling rehab process. I don’t know why I feel that way. I just do. And yes, I recognize I sound like a 15-year old girl. But my blog readers deserve nothing less than my un-filtered emotions.
Since I re-injured my knee this summer, my weight’s swung 5-10 lbs several times. After first injuring my knee, I couldn’t exercise for a few weeks because the back of my knee swelled up like Barry Bonds’ noggin. Add 5 pounds. After the swelling subsided, I decided to have surgery, but postponed it for a few months. I decided to get in the best possible shape pre-surgery. Plus, I wanted to get my body “bikini-ready” for my October vacation to Maui. I realized most beachgoers would be staring at my wife, not me, but I still have pride. Besides, you never know when the paparazzi might be lurking.
Over the next 2 months, I ate extremely healthy. You know what? Eating right is 100x more important for getting in shape than lifting weights or doing cardio. Had I known that I never would’ve eaten all those chicken patties back in high school. I single-handedly kept Tyson’s in business. Anyway, 12 pounds disappeared. I didn’t win any bodybuilding competitions, but I trimmed up considerably. I joked that instead of 6-pack abs, I had a 2-pack. I’m not going to lie: In Maui, women swooned when I took off my shirt. I kept waiting for the shirtless beach photos to show up in The Enquirer, but no such luck.
I came back from vacation feeling bloated; that happens when you gorge on nothing but burgers, beer and ice cream for 1 week. Add 5 pounds. Unfortunately, I wasn’t able to drop those pounds right away. After we returned from Maui, I went out of town twice, and my eating and workout schedule always gets jacked up when I travel. And then it was time for Part One of the ACI surgery.
Arthroscopic surgery really isn’t that big of a deal. After all, pro football players routinely play a week or 2 after getting scoped. But I’m not a pro athlete. Frankly, I’m not even a true professional. I mean, I work for the government. Anyway, I hardly exercised for the next 3 weeks while my knee healed. Add 5 more pounds. But the great thing about eating right is that once you’ve done it, your body quickly recaptures the virtues of eating veggies and grilled chicken. It’s like riding a bike. After a week or 2 of eating right and exercising again, I’m back to my Maui weight, though my abs lost half of my 2-pack. I guess I’m sporting a 1-pack now.
I’ve got 3 or 4 weeks to reclaim that 1-pack. But I’m not stopping there. In fact, I plan on carrying over this attitude to rehab, and there’s nothing more hardcore than showing up for PT with your face painted. If I fail, I might be the first contestant on The Biggest Loser who’s “before” picture was half-red, half-black.
Sunday, December 7, 2008
Still waiting. . .
No surgery date yet. I joked that the cloning company, Genzyme, must be having a good year. It seems like every company is stuffing sales into year-end to make its numbers, yet my surgery likely will get pushed into 2009. I’ll welcome in the New Year, and then quickly accomplish everybody’s #1 resolution: getting a cloned knee.
On Friday, I met with my OS and Jimmie, a specialist from Genzyme. Jimmie was great. Part salesman, part trainer, he’s knowledgeable about the ACI surgery, having trained many orthopedic surgeons in this innovative procedure over the past decade. More importantly, Jimmie’s a terrific communicator. Before the OS arrived – by the way, why do doctors always keep you waiting for 40 minutes? – Jimmie and I spoke at length about the surgery and rehab. For each knee component, he used an analogy to enhance my understanding of the role each part of the knee played. He’s like a medical translator. This isn’t to diss Turgeon the Surgeon. Turgeon is personable, takes his time, and patiently answers all of my questions. He’s also regarded as one of the top ACI surgeons in the area, which, obviously, is kinda important. Sometimes, however, Turgeon forgets that I don’t speak medicalese, and Jimmie bridged that gap handily.
As a representative of Genzyme, one of Jimmie’s jobs was to review my medicals and confirm I’m a candidate for ACI. Jimmie quite bluntly told me, “Not everybody qualifies for ACI. Genzyme doesn’t want the wrong candidate who will screw up the company’s success rate.” Jimmie was like the anti-Chief Burrell, the Police Commissioner from The Wire who wanted to “juke the stats” to make Baltimore’s crime rate appear lower. I qualified as a “good candidate” for ACI. I’m not sure if that’s meant to be a compliment.
The 3 of us reviewed my MRI results and discussed the 2 lesions to be filled. The lesion on my patella is the smaller of the 2, but it’s trickier than the trochlear groove defect. Patella lesions historically have the worst ACI track record, largely because patellas absorb most of the pounding on a person’s knees. Moreover, the underlying injury often screws up knee alignment, which further increases stress on the knee. Over several years of trial-and-error (an expression that doesn’t comfort patients), surgeons discovered ACI implants in the patella were more successful when combined with a procedure to alleviate the stress on the patella. Jimmie said adding the second procedure improves the success rate by almost 20%. Usually, this means re-aligning the patella that got jostled during injury. In my case, however, my knee alignment is stable. Basically, my knee’s perfectly fine. Well, except for the 2 holes that shouldn’t be there.
Nonetheless, a similar procedure can still alleviate stress on my patella. During the ACI surgery, Turgeon will slightly raise my patella by a smidgeon (not a precise medical measurement). This doesn’t sound like a lot, but wait until you hear how doctors elevate the patella. In a procedure called a distal realignment (my particular version is called a Fulkerson), the surgeon breaks the edge of the tibia bone and re-connects the bone to the raised patella with a handful of screws. Yes, it’s supposed to be as painful as it sounds. Of everything that the knee suffers during the ACI surgery, this is supposed to hurt the most, though the pain generally subsides during the first 2 weeks. Of course, the screws will set off airport medical detectors for years to come...
Right now I’m waiting on final approval of the surgery from Blue Cross, Blue Shield, my insurance carrier. BCBS was at the forefront of coverage for ACI, and, according to Turgeon’s insurance liaison, covers ACI. Under my particular insurance plan, all surgeries are covered at 100%, minus $100 surgeon fee. Unfortunately, insurance carriers aren’t known as benevolent entities, even during the holiday times, and since ACI surgery costs $30,000 – new knee or new car? – I’m expecting some hassle over coverage. Don’t be surprised to see blog entries entitled, “BCBS is the devil.”
Once BCBS approves the surgery, Genzyme will produce 4 vials of my cartilage cells. Each vial contains 12 million cells. Turgeon doesn’t think he’ll need 48 million cells to fill my defects. I’m hopeful I’ll be able to take the leftovers home in a “To Go” vial. You know, just in case I need a few million cartilage cells some day.
On Friday, I met with my OS and Jimmie, a specialist from Genzyme. Jimmie was great. Part salesman, part trainer, he’s knowledgeable about the ACI surgery, having trained many orthopedic surgeons in this innovative procedure over the past decade. More importantly, Jimmie’s a terrific communicator. Before the OS arrived – by the way, why do doctors always keep you waiting for 40 minutes? – Jimmie and I spoke at length about the surgery and rehab. For each knee component, he used an analogy to enhance my understanding of the role each part of the knee played. He’s like a medical translator. This isn’t to diss Turgeon the Surgeon. Turgeon is personable, takes his time, and patiently answers all of my questions. He’s also regarded as one of the top ACI surgeons in the area, which, obviously, is kinda important. Sometimes, however, Turgeon forgets that I don’t speak medicalese, and Jimmie bridged that gap handily.
As a representative of Genzyme, one of Jimmie’s jobs was to review my medicals and confirm I’m a candidate for ACI. Jimmie quite bluntly told me, “Not everybody qualifies for ACI. Genzyme doesn’t want the wrong candidate who will screw up the company’s success rate.” Jimmie was like the anti-Chief Burrell, the Police Commissioner from The Wire who wanted to “juke the stats” to make Baltimore’s crime rate appear lower. I qualified as a “good candidate” for ACI. I’m not sure if that’s meant to be a compliment.
The 3 of us reviewed my MRI results and discussed the 2 lesions to be filled. The lesion on my patella is the smaller of the 2, but it’s trickier than the trochlear groove defect. Patella lesions historically have the worst ACI track record, largely because patellas absorb most of the pounding on a person’s knees. Moreover, the underlying injury often screws up knee alignment, which further increases stress on the knee. Over several years of trial-and-error (an expression that doesn’t comfort patients), surgeons discovered ACI implants in the patella were more successful when combined with a procedure to alleviate the stress on the patella. Jimmie said adding the second procedure improves the success rate by almost 20%. Usually, this means re-aligning the patella that got jostled during injury. In my case, however, my knee alignment is stable. Basically, my knee’s perfectly fine. Well, except for the 2 holes that shouldn’t be there.
Nonetheless, a similar procedure can still alleviate stress on my patella. During the ACI surgery, Turgeon will slightly raise my patella by a smidgeon (not a precise medical measurement). This doesn’t sound like a lot, but wait until you hear how doctors elevate the patella. In a procedure called a distal realignment (my particular version is called a Fulkerson), the surgeon breaks the edge of the tibia bone and re-connects the bone to the raised patella with a handful of screws. Yes, it’s supposed to be as painful as it sounds. Of everything that the knee suffers during the ACI surgery, this is supposed to hurt the most, though the pain generally subsides during the first 2 weeks. Of course, the screws will set off airport medical detectors for years to come...
Right now I’m waiting on final approval of the surgery from Blue Cross, Blue Shield, my insurance carrier. BCBS was at the forefront of coverage for ACI, and, according to Turgeon’s insurance liaison, covers ACI. Under my particular insurance plan, all surgeries are covered at 100%, minus $100 surgeon fee. Unfortunately, insurance carriers aren’t known as benevolent entities, even during the holiday times, and since ACI surgery costs $30,000 – new knee or new car? – I’m expecting some hassle over coverage. Don’t be surprised to see blog entries entitled, “BCBS is the devil.”
Once BCBS approves the surgery, Genzyme will produce 4 vials of my cartilage cells. Each vial contains 12 million cells. Turgeon doesn’t think he’ll need 48 million cells to fill my defects. I’m hopeful I’ll be able to take the leftovers home in a “To Go” vial. You know, just in case I need a few million cartilage cells some day.
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