An Impromptu 32-Week Visit and Firsthand Exposure to the Health Care Reform Debate

Last month I had an MRI of my gimpy knee. As I blogged about earlier, the MRI technician/specialist/whatever-his-title-is, thought he was checking for a torn ACL, not an ACI repair. Hey, mistakes happen, right? Well, he still wrote up a report. When I met with my surgeon last month, however, the report was not available. Instead, my surgeon told me he asked the MRI guy to re-do the report, which, I thought, meant focusing strictly on the ACI repair. Bad assumption, it turns out; more on that in a moment. Meanwhile, we reviewed the actual MRI pictures together, and Dr. T shared the good news that everything looked great. I still wanted the report, though. Dr. T said he would send me the revised report when it was available. He knows that, as a lawyer, I like written reports.

A few days after my appointment, I had yet to receive the “revised” MRI report. It turns out the guy never re-did his report. Instead, he simply noted on a separate cover sheet his mistaken assumption about my ACL. That’s it. Considering how much MRIs cost, that MRI probably wasn’t a good use of health care dollars. Consistent with today’s debate over health care reform, they’re not “my dollars” so, frankly, I’m not too concerned. Sad, but true.

Anyway, I still wanted a copy of the report. Even though it focused on my ACL, it nonetheless examined other parts of my knee, so that information would be helpful and I was anxious to review it. I finally received it about one week after my appointment.

Incredibly, the report failed to mention the ACI-repaired lesions on my patella and trochlear groove. At first, I thought this was yet another example of the technician’s incompetence. I don’t think it’s a stretch to say that the guy who mistakenly checked for a torn ACL would also miss a cloned graft, right?

Apparently not. When I finally reviewed the report with my surgeon, Dr. T told me he actually spoke with the MRI guy, who told him he was surprised to learn I had undergone a cartilage implant. When he examined the MRI, he simply didn’t notice any difference in the consistency between the “old” cartilage and the “cloned” cartilage. Now, I’m hesitant to do the Tiger Woods double fist pump because of the guy’s earlier screw-up. But it’s hard not to be pretty stoked.

(Speaking of Tiger, why didn’t the CBS golf announcers state the obvious at the PGA Championship: Tiger choked on those last few holes. Period. Even Michael Jordan missed potentially game-winning shots. It happens. Yeah, it sucks when your off day just happens to be during the final round of a major in a year in which you hadn’t won one. But there’s no shame in that. Hey, even the best f*ck up. Ok, back to my knee)

The MRI report, however, did identify some areas of concern, which I discussed with Turgeon. Incredibly, it said I had a torn meniscus on the medial side of my posterior horn.

What the f*ck?!?!

For the past 7 months, I haven’t been preparing for my UFC debut or even playing pickup hoops. Nope. I’ve spent my time on the couch or hobbling around an office with a bunch of government drones. My craziest activity has been riding a stationary bike – not exactly the kind of situation that leads to torn meniscuses, you know.

Before I share my conversation with Dr. T about the MRI report, let me explain a few things about a meniscus tear before friends and family freak out. First, this “tear” has nothing to do with the areas of my knee repaired by ACI. Totally unrelated (well, except for the fact that multiple knee surgeries surely have made my knee more prone to injury). Next, in the world of knee surgeries, a meniscus tear is pretty minor. Usually, a simple scope cures it. I’ve actually felt a slight twinge of pain in this particular spot for a few months. Nothing serious, though. The discomfort rarely lasts more than a brief moment, and doesn’t impact my daily functioning. I mean, I don’t want to downplay a meniscus tear. But I’m not overly concerned, other than how I could’ve possibly torn it during my recovery. I’m still shocked.

Despite what the report says, Dr. T isn’t convinced my meniscus is torn. During our initial review of the MRI pictures, I recall he noted some splotches on the MRI of some minor concern. I’m not sure he was pointing to the meniscus. But during our follow-up, he showed me the affected area. There was some “grayness” there, which apparently might be indicative of a possible tear. However, it wasn’t large or deep enough, in Dr. T’s mind, to say definitively, “Yes, it’s torn.” He said the only way to tell would be if he scoped my knee.

Of course, my response was a subtle, “No f*cking way.”

I only want him – or anybody – cutting me open if surgery is absolutely necessary. And it’s not necessary to “scope me” just to see if it’s torn.

So, as of now, I’ll just continue rehabbing as usual. Actually, Dr. T wants me to step things up to improve my quad strength. He reiterated that everything looks fantastic with my knee; he’s ecstatic how things turned out. Now it’s time to put Lou Ferrigno to shame with my workouts.

We also took another X-ray of the osteotomy, something we do at every visit. My screws and the bone wedge continue to irritate me. The screws bulge from my shin like the belly on a 9-month pregnant lady. You can read the Black-and-Decker label through my skin.

Things have gotten better, but I still feel like the osteotomy is holding me back, even more than the actual surgery. After reviewing the X-ray, Dr. T isn’t surprised. While the bone has filled in just, he says it’s continuing to harden, and thus the bone remains sensitive. Normally, the hardware can be removed at the 12-month mark, but in my case he suggests waiting several additional months to give the tibia extra time to heal.

Next up is another MRI in October, at the 10-month mark. Dr. T mentioned this time they’ll do a bunch of other stuff to specifically focus on the cartilage. My first thought? Uh, why didn’t they do this type of review the last time? Is there a particular reason to do another MRI only 3 months later? Again, because I’m not paying (I don’t have a co-pay for MRIs), I’m not complaining. The extra information can only benefit me. But this just seems symbolic of the current debate over health care waste. Maybe the additional test is just covering for the previous screw-up. I’m not sure. But part of me – that speck of a conscience buried far deep inside and which rarely surfaces – feels a bit uncomfortable being a party to possible wasteful spending.

And then I remember how often insurance companies screw over patients, and those concerns begin to fade away.

Passing the Beach Test

I almost posted a mega blog entry, but decided to split it up into two postings. The original posting was dangerously approaching the length when reasonable people would say, “ok, no human should write that much about their knee.” Hopefully the 2nd posting will be ready within one week’s time. It will cover my 32-week appointment and review of the report from the MRI previously discussed. I know you’re anxiously awaiting it.

Alright, the Summer of Travels (and delayed blog entries) is officially over. Multiple trips to DC. A long journey to Stockholm. But neither trip compared to, or could prepare me for, my first family Griswold Adventure: we drove from Dallas to Pensacola, Florida. 2 kids. 2 portable DVD players. A box full of granola bars and Pepperidge Farm Goldfish. At least 17 “Are we there yets?” A packed SUV. 660 miles. 13 hours. Ah, the closeness and joys of family.

I was admittedly a bit nervous about how my knee would handle the beach, namely the unevenness of walking in the sand. In addition, I was concerned with my ability to remain steady when waves crashed into me, whether it was carrying my 4-year old daughter a few feet from the shoreline or wading into the deeper waters with my 7-year old son. The knee held up well. No issues whatsoever. Jim’s Knee 1 – Gulf of Mexico 0. Now, I’m not about to join the pro beach volleyball tour anytime soon; Karch Kiraly’s AVP record is safe. But only a few weeks ago, I wondered whether I would ever regain some semblance of athletics. Yet, at least for this trip, my knee actually felt “normal.” Maybe, just maybe, it even felt a little spry.

While the instability of my knee never strays far from my thoughts – I probably think about my knee probably every 10 seconds – after my first day I stopped worrying whether my gimpiness would prevent me from enjoying my vacation. That was a refreshing feeling. I can just picture my fellow ACI patients nodding approvingly. In fact, right now my immediate goal is that my knee reaches a certain level of comfort so I no longer think about it constantly. Pretty high bar, huh?

The lengthy drive didn’t crush my knee, either. I drove the entire way home, all 13 hours. Now, with kids, this wasn’t 13 hours straight. In fact, we probably stopped 3-4 times in the first 5 hours alone. You really can’t tell little kids to “hold it” or pee in an empty water bottle, especially a 4-year old girl. It’s just not happening.

My parents, on the other hand, were old school. The car never stopped, unless it needed gas. Maybe, just maybe, if I begged enough my dad would slow down the car to 55 mph and let me roll down the window and pee from the moving car. Of course, my dad first made sure the wind couldn’t blow back my urine into his prized Gran Torino.

I’m not medieval like them (just kidding, Mom and Dad. This trip gave me an increased appreciation of your parenting skills). Seriously, all the stops make the drive more bearable, and gave me plenty of chances to stretch my knee. Did you know that Hattiesburg, Mississippi has a phenomenal rest area? Top notch. They even offered free, freshly baked cookies. I highly recommend it.

Sweden Rocks! - 7 Month Update

No, that’s not a typo. Nor am I Drew Carey, absentmindedly confusing the “mistake on the lake” with the “city by the water” (funny aside – I thought Stockholm was divided by a bunch of rivers; it’s actually dissected by the Baltic Sea). Speaking of Drew Carey, I never thought he was very funny, but I recently caught a glimpse of him on The Price is Right. Man, he’s fallen off the funny cliff. Paraphrasing the Dan Quayle debate insult, “I knew Bob Barker. And Drew Carey, you’re no Bob Barker.”

Anyway, I enjoyed a week of investigating in Stockholm, Sweden. Yup, that’s right. There’s securities fraud on every corner here, right next to the outdoor cafes. Corrupt Swedes.

Nah, I’m just kidding. The Swedes are good people. In fact, Uffe, some random 50-year old dude who sat next to me at the pub on Friday night bought me something called a Hoegarrden. It was more like a lunch bucket of beer than a mug. Coincidentally, it’s Gay Pride week here. There were probably 20,000 folks celebrating in the streets on Saturday afternoon. In fact, the loud clapping, whistling and continuous playing of the Village People interrupted my power nap. I don’t think Uffe was hitting on me. Not that there’s anything wrong with that. But he was at the pub with his wife. We did, however, swap phone numbers. You know, just in case I’m ever back in Stockholm or Uffe visits Dallas.

This was my first visit to Stockholm. A nice, relaxed, friendly city. Very clean and active. Everybody seems to either walk or bike places. And they take 3-hour lunches, usually at some outdoor café. I could get used to this lifestyle. In fact, in a perfect world, I’d spend my day sitting at one of these outdoor cafes with my laptop, cranking out blog updates and finishing the mystery novel I’ve been working on for the past 3 years. And then I’d hop onto my Mary Poppins bike and pedal home, tweeting my bell/horn whenever an idiotic tourist wandered into the biking lane. One more thing: I’ve never seen so many pregnant women in my life. And not just pregnant, but bursting at the belly, ready to pop, 9 months pregnant.

How does all of this apply to my knee? Well, let me tell you.

The Stockholm trip was the culmination of a busy summer of travel, hence the lengthy gap between blog postings. This was my third flight in the past 2 weeks (before Sweden, I had two overnight trips to DC). My knee held up just fine on the flights. While the DC trips are a beating, the Stockholm flight really sucks. We fly from Dallas – Chicago (2 hours) and then from Chicago – Stockholm (9 hours), not including the mad “dash” across O’Hare to make my connection (actually, it was more like an old person power walk). The knee got a bit stiffer than usual, but a few laps around the cabin loosened things up.

The knee also handled all the walking around Stockholm. I must’ve walked over 5 miles on at least 3 separate days, perhaps as much as 10 miles on one day, most of them on uneven cobblestone. No problems. I also went up and down plenty of steep steps. I did grip the railing, not because I needed to, but as a precaution. The knee still doesn’t feel “normal” going up and down steps. Actually, it’s fine going down, but heading up still feels abnormal. The strength just isn’t there. If I push off oddly, the knee lacks total stability. (It’s also possible I might’ve torn my meniscus, which, hopefully, is unrelated to the cartilage repaired by ACI. I’m waiting to hear back from the surgeon. Will post more when I get some answers). While the knee doesn’t hurt and I really wasn’t limited in what I could do – other than being unable to sprint across the street if a car came barreling through the intersection – the inability to move freely is frustrating. Again, the analogy of an athlete past his prime struggling to acknowledge his body’s limitations is the best way to describe my situation.

At this point in the rehab, I still struggle over whether the surgery was “worth it.” Unlike most other ACI patients, I wasn’t in daily agony, or unable to function properly. The knee occasionally suffered sharp pains, but I was generally able to perform basic athletic activities, though I couldn’t run or jump without extreme pain/difficulty. I opted for surgery because I was concerned that things were about to go downhill, and didn’t want to reach that abyss when it would be too late to repair my knee.

And that’s what makes my Monday Morning Quarterbacking over the surgery decision difficult. Yeah, I’m still worse off now than I was before the surgery. But it’s foolish to think my quality of life wasn’t about to experience a steep drop if I hadn’t gotten the surgery. Of course, part of me wonders whether I could’ve contained the pain/uncomfortableness by curtailing my activities, while still preserving my ability to perform simple athletic activities. Maybe that’s wishful thinking. I don’t know. Thinking about the “what ifs” really sucks.

I hope that my recovery progresses to the point where I function at least at the level I was at pre-surgery. If so, I’ll consider that a success, because, like I said, I suspect that things were about to get worse. Even at 7 months, it’s still too early to tell whether the ACI surgery “worked,” at least worked as I hoped it would. I feel like it’s election night and the polling places have just closed, but the race is still “too close to call.” In real life, unfortunately, I won’t know the results when I wake up the next morning…