- Under my current health insurance plan I had virtually no "out of pocket costs" with my knee replacement or a shoulder surgery in 2004. Since my health insurance is through one of our insurance companies group plan who our office won't do business with much longer It made sense to "gitrdone" now instead of later.
- I saw the amounts that hospitals billed my insurance company versus what got paid. I figured neither one was real happy about the relationship. Sure enough my insurance company and the hospital/doctors are currently arguing about continuing the contract beyond July 01. My surgery is scheduled for June 26 and has been "approved" so this procedure is "covered".
- I had 2 ugly looking knee joints with both legs bowled outward. Now my replaced knee is almost normal sized and straight. So even though my right knee is not nearly as painful as the left before surgery I'm ready to replace it too.
I was suppose to donate 2 units of blood before surgery. When I went to donate the first unit my hematocrit level was 32. Normally it should be over 38, so the Red Cross took one unit, but told me that would lower my level to a point where it would not be possible to donate a second unit in time. Called doctor's office and they OKd one unit.
I prepared by cycling a century on Saturday, 25 miles on Sunday and walking 2 miles to Piedmont Hospital. The actual surgery took 87 minutes (I got that from the Doctor afterward) and I was in my room by 11:00. Just like my other joint replacements I had an epidural injection instead of general anesthesia, but this time I actually talked to the Doctor during surgery. They had put up a screen so I couldn't see my knee, and I asked if they had started--they had because I could hear the tool background noise and was aware my leg was being manipulated. I felt no pain what so ever.
Post--op pain in my knee was minimal as the epidural remained in place overnight. When Doctor Wilkes visited on Tuesday he told me the incision was longer than the last one and he cut into my quadriceps to get a large spur above my kneecap. He thought recovery would be similar to last time barring any complications. I made plans to go home on Wednesday. However, nurses/staff seemed to be taking a lot more vital signs and blood samples. They mentioned my blood levels were low and on Tuesday afternoon they gave my donated unit back. It only takes a few minutes to donate, but it takes a couple hours to return it. On Tuesday night/Wednesday morning the drainage system started to leak at my knee which slowed drainage. I was concerned because I was draining a fair volume and last time my leg swelled a lot the day after discharge and I was trying to prevent that from re occurring.
On Wednesday Doctor Wilkes removed the drainage tube and changed the bandage. We discussed my low blood counts--still way too low even after transfusion-- and he agreed to call my primary doctor (Marshall Levine) to check this out further. Fortunately this did not prevent my discharge and I was home by 11:30. I got a CPM machine and spent the the day icing and moving the joint. The technician told me not to set the machine beyond 90 degrees until the first set of staples are removed. Dr. Levine called and we set an appointment for Friday. He was concerned because of the contract dispute between Piedmont and BCBS (GA). Dr Levine called Monday to confirm my red blood count was low--everything else normal. However, since the Blue cross contract expired July 01 he could not refer me to a blood specialist. I wound up with a new primary care doctor with a referral to follow (see a future post on medical care/insurance). New doctor referred me to someone at Emory and they couldn't see me until September.
13 days post--op I still have a fair amount of swelling and discomfort. This surgery was definitely more than minimally invasive. Incision was 8 inches (left knee was 5) and the doctor had to cut my quadriceps to remove all the spurs. It was harder to do rehab and I had to leave work early to ice my leg. Therapist thinks it looks great and considering what they did he's probably right. I still thought I could get back on the road before August 01.
07/16/06 Got on a stationary bike today--one day ahead of previous knee replacement.
07/26/06 Post--op visit. Things looked good although swelling still an issue. Had to undergo an ultra sound at Emory to confirm no blood clots. That was my last visit to the surgeon. I didn't go back because I knew the knee was doing fine.
07/29/06 Back on the road again. One day sooner than last time and a few more miles. I did 27 miles in just over 2 hours. The initial 18 miles were done in 80 minutes. I felt good enough to do some more riding but as I continued cycling I had to slow down. Probably pushed it a little bit but it felt so, so good to be riding on the road again. It hurt so good!!
Blue Cross and Piedmont worked things out and I was able to return to my primary care doctor who got me to a hematologist in August. Diagnosis was anemia with no real idea why. I went on a high iron dose and scheduled a possible bone marrow biopsy in a month.
During August I continued physical therapy and did 11 road rides, most between 25--30 miles. On 08/27 I rode in north GA and went 55 miles. The first 30 were pretty easy but once I got to the last gap climb (Neels) I was tired. I limped up the 3 mile climb suffering a lot--normally this was an easy climb, but not today. It was partly my knee not being used to doubling my mileage and partly the anemia.
I continued increasing my cycling and therapy during September. When I went back to my hematologist he decided not to do the bone marrow biopsy because my counts and profile were improving. That probably meant my anemia was the result of iron deficiency because of the 2 knee surgeries. That also meant I got a little extra exercise walking 2 miles to his office since I wouldn't be able to drive after the biopsy. So I just walked back home after stopping for a huge breakfast since I had to fast.
My major recovery goal was to complete the 6 Gap Century on 09/24. I rode the back 3 gaps one week before the event and knew that while I might be able to complete 6 Gap I would pay a huge price. So I did the 3 Gap. It rained through entire ride but I felt pretty good. I was sure my anemia was disappearing because I could ride faster with less effort and do harder intervals without fading.
I continued weight lifting and riding through October. In early November the hematologist said all my counts were completely normal. The final diagnosis was anemia due to iron deficiency as the result of 2 surgeries and blood donations. I wasn't surprised because I could feel a big difference in my fitness level compared to earlier in the year.
On 11/18/06 I did El Tour de Tucson--my first century after the second knee replacement. It was almost effortless. I rode with team mates and helped pull several pace lines and individuals during the ride. The only mishap was a flat tire at mile 90. I've participated in this event 7 times but always as a coach helping and looking after my team. Someday I want to do this ride on my own to see how well I could do.
So 2006 (my 60th) was a good year. Back in 2005 I had planned to achieve some mile stone like 60 centuries, 6 or maybe 10 six gap centuries, etc. I wound up with only 4 centuries in 2006. But I have 2 new knees, improved range of motion, straight legs and no health issues that I'm aware of. I'll settle for that and plan some goals for future years. One goal is no more orthopedic surgeries--10 in one life time is already way too many!
