Monday, June 23, 2008

Decisions, decisions

I am at Dr. C’s office now – he was recommended by Andy. His daughter, Alison, had her ACL reconstructed by Dr. C. She did an autograft (her own patellar).

Yesterday I went canoeing and then to a movie – afterwards my calf and ankle were quite swollen. I really hadn’t thought too much about it; I thought that it happened because I was seated most of the day. It turns out that it was a good day to see doctors.

This morning I saw Dr. A – he’s the doctor that reconstructed Eric’s ACL using an allograft (cadaver). He saw some interesting stuff. First, he noticed how swollen my ankle was and this concerned him. I’ve noticed that when a doctor is concerned, one should worry a little bit. He thought that I might have some sort of blood clot (when I think of blood clot, I think of something going to my brain and killing me) and possibly DVT (Deep Vein Thrombosis – don’t quite know what this is, but I will look up. I have heard of DVT but only when I’ve been flying). So back to my knee…Dr. A looked over the x-rays. He showed me the bone bruise that is typically seen in ACL tears. He showed me the PCL (posterior cruciate ligament) which was still intact. And then he showed me some things that again freaked me out. Apparently, I also have some articular cartilage defect (not sure what the manufacturer’s warranty on that is…). This will require micro-fracture surgery and/or (not sure yet) an OATS procedure. I have to look these up. He also mentioned damage to my medial femoral condyle. All sounds so wonderful. His concern first was the cartilage damage – apparently the cartilage isn’t easily fixed, that’s where the different surgeries come into place. All I know about micro-fracture surgery is that Amare Stoudamire and Greg Oden have had it done and it Amare 2 years to get back to playing shape. We’ll see about Greg Oden. At least they have million dollar contracts in the bank…got to love the guaranteed contracts in the NBA.

Dr. A scheduled an Ultrasound for my blood clot. That was interesting – I only thought that ultrasound was for pregnant women. Little did I know that ultrasound was used for diagnosing blood clots! So they put gel on my leg and tried finding a clot, which they did not (thank God!). My appointment with Dr. A began at 8:30 and I got back to DC at 1:30. Dr. A followed up with me to go over the results with me, which I found to be very professional.

(Now writing after meeting with Dr. C.) Dr. C discussed with me the surgery options. His opinion was that because I am tall and heavy (6’3”, 200 lbs) with big feet, a long femur, and a long tibia and fibula, that I should use an autograft instead of an allograft. His judgment was based on my aforementioned physical attributes, my age, and my future athletic goals. He said that because I am big and long, I will put more pressure on the ACL specifically and the knee in general than a lighter or shorter person. This alone might cause me to “stretch” a cadaver graft. My age was a factor because I am young enough to still push it athletically for years to come. He mentioned that if I were 44, then he might lean towards a cadaver and that if I was 74, then he definitely would use a cadaver. Of course at 74, I just might know the cadaver. Maybe at that age I just might be the cadaver! Finally, the athletic factors in favor of the autograft option were my future athletic goals of playing basketball and soccer again as well as the type of training that I do. Dr. C told me that I will need a strong ACL replacement and the professional basketball players that he’s worked with have done the autograft option.

After thinking about all the options I decided that would go the route of an autograft. Dr. C sold me on that option. Now, I had to choose a doctor.

The decision-making process on choosing a doctor was tough – I felt that they all knew their stuff, but which one would be best for me and how would I decide.

Dr. D was the first doctor I saw, so I had no level of expectation, I didn’t know what questions to ask – basically I was in the dark. He went over everything with me, but since I was clueless at our initial meeting, I felt like I was rushed, but at the same time in capable hands. He assured me that he would fix everything, check out the knee for possible other (read: cartilage) damage. When I left his office I felt that I had scheduled a surgery that I knew little about.

When I saw Dr. A, I was more informed that my initial doctor visit. I had a bunch of questions and he had answers. When he showed concern with the swelling I felt that this guy really cared and would look after me. He gave me his cell phone number and called to follow up after the ultrasound. He also showed me what he saw on the MRI and explained what it all meant and what the options would be. He was indecisive on the surgical options for ACL reconstruction as his main concern was the cartilage damage.

Dr. C was the most “doctor” of all three – he was very matter-of-fact and I felt that this guy would do a fantastic job. However, I felt that since he was older that he was would use “older” methods, i.e. not stay up with the latest in ACL replacement trends or surgical techniques. It was funny, but I judged him on his age and the layout of his office – it was old and not modern, where Dr. D and Dr. A both had modern facilities, with Dr. D having the best. Maybe it's the businessman in me - I see a new, modern facility and I think: "this place is doing well, which means that they're doing good work, which means that they will look after me."

Later that same week I called Dr. D to talk about the issues and questions I had with the different surgeries. Since I was a bit more knowledgeable that I was the first time we met my questions were more on point and his answers made more sense. My concern was this: Why would I want to damage a perfectly good patellar tendon to repair the ACL? Wouldn’t I be “robbing Peter to pay Paul”? Wouldn’t I be better off with a 100% patellar tendon and a cadaver ACL? Dr. D explained that the autograft would fit better since it’s basically the same length as the ACL and that a cadaver would be hard to match. Plus, the patellar tendon would fill in over the next 2 years to the point where it would appear to be normal under an MRI. That answer alone was enough for me to feel more comfortable. Add to the issue that my body might reject a cadaver or I might get something from it (highly unlikely, but sill a concern.) At the end of the phone call I felt better about both the operation and the surgeon.

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