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.