“What are we going to do with you? We can’t shoot you…” Very reassuring words from my OS. Glad we’re clear on that point.
Actually, I cracked up when he said that to me. We’re both pretty frustrated at this point, and I appreciate his ability to bring some levity to the situation.
Last week was a total whirlwind of doctor appointments and treatment plans and insurance. I saw my primary OS early in the week, and the long and short of it is that he agreed with the second opinion OS. What does that mean? That means that I have a new chondral defect in my lateral tibial plateau with a degenerative bony cyst, a spot on the medial side of my patella that didn’t fill completely with the DeNovo graft with bony edema indicative of patellar overload, significant scar tissue in the anterolateral area of my knee, and significant signal abnormality in my patellar tendon indicating patellar tendonitis. There were a few other inconsequential things noted, such as borderline patella alta (kneecap sits too high), a 9mm lateral subluxation of the patella (within normal range), and a bone island on the medial femoral condyle (a harmless deposit of compact (hard) bone in the cancellous (marrow) bone). But what does that all mean? That means that both surgeons agreed that I need additional surgery to address the issues.
The kicker was that, while he agreed with the suggested surgery, my primary OS said he thought I would have a better chance for a positive outcome if the second opinion OS did the surgery. I really appreciate his candor (more than he knows), but… suck. I have zero desire to go back to the second opinion OS. By all accounts, he’s an excellent surgeon and one of the leading experts in the country for cartilage restoration. Doesn’t matter. I left my last appointment with him feeling like he had no real interest in helping me; I was in tears before I made it to the parking lot (and, as I’ve mentioned before, that’s not my normal reaction to anything). I’ve decided that I won’t go into detail publicly here because perhaps he was just having a bad day. I’ve been trying to give him the benefit of the doubt, but that doesn’t change the fact that I don’t want to go back to him.
I diplomatically expressed my feelings to my primary OS when he was talking about sending me back to the second opinion doc. He mentioned there was another cartilage expert within a half-day’s drive that I could try to see, if my aversion was really that strong. I’m not sure how reasonable that is, given that my aversion is based on personality and communication, rather than actual surgical skill. He agreed to ask one of his partners if he thought he might be able to do the surgery, but he didn’t seem to think he’d tackle it either. I am rational enough to know that I should not be making these decisions based on whether or not I like the guy, but it’s hard not to take that into consideration when you’re trusting him to cut you open and fix you up. You want someone you believe truly wants to help you. Plus, you have to go back for all of the follow-up visits. I would go to him for the surgery, if that’s really the best option. I wouldn’t be happy, but I would do it.
I asked what I could do in the meantime because no one wants me to be on the narcotics, least of all me. He said that we could try Euflexxa injections again (apparently, Euflexxa has the least amount of chicken goop in it and isn’t as likely to cause allergic reactions). I was waffling whether or not to go through with them because they didn’t seem to help much last time, and my doc didn’t exactly inspire confidence when he said it’s not going to hurt to try them because “we’re just grasping at straws.”
As I was busy waffling, I got a call to schedule the injections. And to let me know that the partner had said he would do the surgery. But first, he wanted to meet me and discuss what he’d be doing. So I suddenly had an appointment to meet a third surgeon the very next day.
I like this guy. He’s open and straightforward–blunt, really. But I like that he didn’t beat around the bush. He looked over my scans, examined my knee at length, listened to my history, and… told me that surgery would be a really aggressive move right now. Say what? I just had two surgeons tell me that I need to have surgery, and I totally went into the appointment with the understanding that we would be discussing what he’d be doing during the surgery. He thought a better course of action would be to have the Euflexxa injections and try another round of physical therapy with a new therapist. (Nothing against my PT! He just said that all therapists come to the table with their own experience and ideas, and a new one might come up with something different to try.)
He also said of the surgery that “doing the same thing over and expecting different results is kind of the definition of insanity.” Yes, but that definition could also easily be applied to the injections and therapy. Been there, done that, got the t-shirt.
I have to admit to being confused and unsure about what I need to do. Because all three docs agree that the injections shouldn’t hurt anything, that seemed to be the path of least resistance. I got the first injection yesterday. Nothing to it. My primary OS’s PA does the injections, and she’s awesome.
I think, for the first time, the cracks in my facade are beginning to show. I’m having a lot of trouble mustering up any enthusiasm or optimism for this next phase. I’m going to give it my all, but it’s just a different feeling now. Before surgery, I was all gung-ho, let’s do this! Now, I’m more like, ok, I can try, if I have to, I guess. It’s kind of a weird feeling, and it needs to go away.
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p.s. Writing that last bit reminded me of The Red Green Show. The Man’s Prayer. “I’m a man, but I can change, if I have to, I guess.” I used to love that show, but I haven’t seen it in a long time. My favorite quote was, “If it ain’t broke, you’re not trying.”