For those who have wondered why no recent posts, I am recovering from a knee replacement, which happened on January 18, which now seems like months ago. I am graduating from my “what on Earth was I thinking stage” to “maybe this will have a happy ending after all stage” but I still have a ways to go. My orthopod doctor friends were right: This is not a procedure to be treated lightly.
Actually I was not all that enthused about the idea of a knee replacement anyway, though when increasing pain in my right knee prevented me from my routine powerwalks, two years ago I decided to take the first step, got knee x-rays and visited the orthopedic doctor at Kaiser Permanente, our health care provider. The doctor, who was not all that much younger than me, after reviewing the x-rays concluded, “Well you clearly need a knee replacement—you have zero cartilage in your right knee– but you are not going to get one here.”
“Why not?” I responded with some incredulity.
“Well, you walked in here didn’t you? Besides if you think you have a problem, my knee is worse than yours. Just take a look at this.”
He pulled up his pants leg and asked me to feel his knee as it creaked when he moved it.
“Well, then why don’t you get a knee replacement?”
“Are you kidding?” he replied, “Do you have any idea what is involved? No way!”
That was all I needed to hear. No knee replacement for me. I hobbled back to the Metro Station to head home, relieved that I had just dodged a bullet.
Some time went by and my condition continued to worsen. One friend said he had a doctor friend who was an expert on knees and I should get a second opinion. I made an appointment and found out to my surprise that he was not an orthopedic surgeon but rather an internist who specialized in regenerative medicine. He said these orthopedic guys really didn’t know what they were doing, and the answer for a bad knee was in stem cells. For a mere $5K he could do a stem cell transplant and it would be cured. The missing cartilage would grow back in a few months, and I would be fine. While he advised that no insurance covers this procedure due to outrageous insurance requirements, he was convinced that stem cell treatments work. He said even the skeptics agree that stem cell transplants have had great success in animals, especially racehorses. By his own informal research, he claimed success with over 80% of his patients, better even than you get from full knee replacements.
The idea of thinking of myself as a racehorse was uplifting and energizing. I envisioned a sleek, black animal charging toward the finish line with crowds cheering. It was not a major step to think of myself as that animal, given up for lost; but now, even though past my prime, I was charging ahead of the pack, stomping the competition with my regenerated knee. In a year I would be back on the tennis courts.
“When can I get one?” I burst out.
He smiled and signed me up for the next week.
I was hyped. The next Friday I hobbled into his office with great expectations as he extracted fat cells (plenty to work with) from my stomach with a large hypodermic needle. With help from his assistant he mixed the cells into a “stem cell cocktail,” which he then injected into my knee. The whole procedure took about an hour, and I was a tad sore but no worse for wear as I inched my way into the waiting room where Embry was patiently waiting to drive me home.
“What do you think?” she asked.
“I think I will have a regenerated knee in no time and galloping in the Kentucky Derby.”
Time passed. The doctor said that I really needed to give the procedure several months to work, and after about a year, my knee would be back to normal. It is debatable whether the procedure made any difference. At first I thought that it did, but Embry remained skeptical, noting that my limp was as bad as ever. In any event, the doctor did give me a questionnaire to fill out regarding my progress but never asked me to return it to him. I was beginning to question the validity of his research.
What really did me in, however, were the periodic visits to the doctor following the procedure to determine progress. One was scheduled for every four to six weeks, which would translate to around eight visits over the course of the year. I went to the first three, each of which involved using an ultrasound device to see how the new cartilage was coming along with the doctor smiling and encouraging me “to keep it up.” The cost of these visits—which took about 20 minutes —averaged about $1,500 each. When my protests regarding the outrageous price fell on deaf ears, I quit going, saving myself about $10,000. As it was, the $5,000 procedure ended up being a $9,500 ordeal. Enough was enough.
So I told myself, maybe I won’t turn out to be a sleek racehorse after all. And really, what’s so bad about having a bad knee anyway? I compensated for giving up my powerwalks by swimming 30 minutes in the lap pool in the basement of our apartment four or five times a week. While life was not perfect, it could surely be a lot worse.
Then came our Japan Trip. I believe I posted this; but if you have not read it and would like to, just let me know and I will be sure you get a copy. Embry had signed us up for what she described as a Road Scholar geezer trip. We would basically be on a bus most of the time going from temple to shrine to temple with a bunch of other old folks, many using walkers and canes. Compared to our around-the-world-without-flying adventure in 2015 and our road trip out West and back in 2016, this sounded to me like a perfect respite. The only problem was that Embry had failed to read the fine print, which rated this trip “most challenging and difficult” involving walking up to five miles a day and exclusive use of public transportation to get around. During the course of this experience—which I am proud to report I did survive but with considerable difficulty– the knee issue bubbled up again to the surface.
The decision to revisit the replacement option actually happened in San Francisco where we stopped for a few days to visit friends prior to boarding our flight to Tokyo. I visited the urgent care center at Kaiser to get them to check on swelling around the knee, which they ended up draining and giving the knee an injection of cortisone. The doctor there seemed very knowledgeable and specialized in sports medicine, particularly knees. When I told him about my stem cell treatment and how much it cost, he said he could not believe it and suggested I report the doctor to law enforcement for armed robbery. While they might work someday, he was emphatic that there was no reliable evidence showing that stem cell treatment was successful for humans. What I really needed was a knee replacement. Period.
“But,” I protested, “They won’t give me one in DC. If you are able to walk into the doctor’s office, you are automatically disqualified.”
“Oh, don’t let that bother you,” he said, “This is just Kaiser’s way of triage. If we performed knee surgery on everyone who wanted one, do you have any idea how many doctors we would need? The boomers have arrived and they all need new knees.”
“So then how do I get a knee replacement?”
“Badger the hell out of them.”
The day we returned from the Japan Walking Tour, I wrote the following email to my orthopedic doctor:
Please confirm for the record the following information:
- Kaiser has concluded that I (Joe Howell) need a knee replacement because I have no cartilage in my right knee.
- Kaiser will not give me a knee replacement because I was able to walk into your office.
- Kaiser will also not sign off on a knee brace permitting Medicare coverage [another incident] because Kaiser only allows their own braces to be used.
Two hours later I received an email response. “Come into the office tomorrow and we will give you a knee replacement.”
So that is how I finally got made my way to the operating room for a knee replacement. The operation did not happen the next day but about three months later and by another surgeon. I refused to let that old guy operate on me and was told that was not a problem because he had retired about the time he received my email. My new doctor was in his mid 40s, all business and very serious. I asked him if he knew what he was doing and he said yes. That was enough for me.
I was later told the operation went well. The main thing I remember was being in the recovery room and hearing two emergency announcements over the loud speaker, “Heart attack in Operating Room D,” and minutes later. “Stroke In Operating Room F.” I made a mental note that at least I had dodged those bullets.
So I am now in Week Three of recovery. By all accounts it will probably take three months before I am back to where I was before the operation and perhaps as much as a year before I forget I ever had a knee problem. Physical therapy is a big part of this, and I am working very hard at it. If you asked me at the end of week one whether I had made the right decision, my response would have been, “Are you kidding me? Whose idea was this anyway?” I now am much more sanguine but taking it a day at a time. Next week my hope is that I will be able to get out and about some but probably won’t be able to drive for another month.
The best part of all this is the afternoon tea and cookies events with friends who responded to Embry’s Doodle poll and have stopped by for visits. That has made all the difference and I am so grateful to Embry for setting these up and for the friends and family who have stopped by.
So now you know why I stopped blogging. Stay tuned for a Faux News posting shortly. Lots of good material these days!