Now I can’t pretend to be an expert on how health care is paid for, but i have had some experience as a consumer paying for two ACL surgeries and a wrist reconstruction in the last 6 years.
This image is captured from my health insurance provider’s website. Frankly I think it speaks for itself. What are these discounts? What do these services really cost?
I can’t claim to know how to fix it, but I am pretty sure this system is broken.
I’ve clearly been horribly negligent of my blogging duties. For that, i’m sorry.
Today is 8 weeks from the day I had my third ACL repair. My recovery has been almost unbelievably easy thus far. A royal hassle and a lot of work to be sure, but compared to my previous to efforts this has been a cakewalk.
There is no doubt that the process is somewhat easier for physiological reasons, but i also give a great deal of credit to my physical therapy. Before i go in to detail about the PT i’ve been doing this time, let me address my previous PT experience.
Towards the end of my PT after my last surgery I started to get the feeling I was being taken advantage of. Surely they gave me good exercises and lots of oversight, but they also were billing my insurance for hours and hours of time in the Russian Stimulation machine that seemed to do nothing. When my insurance benefit ran out my treatments changed somewhat and the billing changed dramatically. It was truly remarkable what they could get the insurance company to pay for. In the end I was mostly a convenient way for them to access the fertile billing grounds of my insurance.
After having began practicing yoga since my last surgery I looked for a PT that did some Yoga Therapy as part of a rehabilitation effort. I found such a person in Carri Kaplan at Bend To Mend.
Carri’s approach to my rehabilitation has been to identify some of the things going on with my body that have made me susceptible to ACL injuries and attempt to address those while rebuilding my strength and range of motion.
Perhaps the best suggestion that Carri’s given me was to stop wearing my big hinged brace after about 4 weeks. She showed me how the brace was causing me to walk, sit and stand in unnatural postures. As such it was causing me a a lot of cramping and encouraging very poor alignment in my lower body.
Every meeting we’ve had has resulted in some kind of a revelation in addition to a great deal of helpful advice and encouragement as i heal.
While I don’t doubt that a more traditional PT experience has it’s benefits I’ve found that this more wholistic approach has done me wonders. More importantly, I’m hoping that by learning more about how my body works and some bad habits I have I will be more prepared to protect myself from future knee injuries.
Thank you Carri!
This being my third ACL replacement surgery I like to think i’ve learned a couple of things that make the process easier. Today I’d like to talk about five things i did to my home to make it the best place it can be for the early stages of rehab.
There’s going to be a time after your surgery where you’re trying to get to the bathroom in the middle of the night on crutches and under the influence of some pretty powerful drugs. But even in less trying conditions we need to make sure that our home is going to be a safe place for us in our new condition.
When you’re crutching your way to the bathroom in the middle of the night the last thing you need is to set your crutch tip down on a rouge sock or piece of paper. Take the time before your surgery while you’re still fairly mobile to clean up and organize. Concentrate on walkways in particular, but also on the areas where you’ll be performing delicate maneuvers: near the bed, in the kitchen and the bathroom.
Cleaning gets a whole lot harder when you’re in crutches and feeling lethargic from the drugs.
In the hours and days immediately after you get home from surgery you’ll be spending a lot of time sitting still in one place. Whether you’re strapped in to a CPM machine, icing the joint or just resting this nesting area will be your daytime home.
At the moment I’m sitting comfortably on the couch with a fresh allograft and a positive outlook on life.
My surgery was this morning and it went quite smoothly. My anesthesia was a bit different this time from what i’ve had previously and it’s made for a markedly improved day of surgery experience.
I’ll do a timeline post later on to help those who are doing this for the first time know what to expect, but the purpose of this post is to simply note that I had the operation, it went well and i’m feeling good.
A quick note on the anesthesia: This go around I got a nerve block in my left leg in addition to the more traditional general and localized anesthetics. In surgery it doesn’t really matter as I was out cold like i always have been. However, come back in the recovery room was a much better experience due to the reduced use of a general anesthetic. By the time I was ready to be discharged my head was quite clear and i felt generally great.
Additionally a large portion of the left leg is still numbed, meaning i’m not experiencing even the slightest ache 6 hours post-op.
Now the hardest part begins. However, my last experience re-habing from an ACL repair ended up having a broader positive impact on my life. I’m hoping this go around will continue that trend and further enable me to engage my body.
And now, back to Mad Men Season3 
The house is all clean, the refrigerator is full of healthy and convenient things to eat. A new ottoman waits for me to elevate my leg on it and i’ve thoroughly scrubbed myself with Hibiclens, twice.
Stepping out of the shower it struck me that it would be the last normal shower i have for a few weeks.
Here we go again!
After much back and forth my surgery is scheduled for a week from today, Jan 17th.
Getting an MRI can be a bit intimidating. In addition to the stress of not knowing what’s going on in your joint you’ll be experiencing a big scary machine for the first time. However, modern MRI equipment is patient friendly and most techs do a great job of making you feel comfortable for your exam.
After the requisite paperwork you will be taken to a changing area where you’ll be asked to remove any garments with metal on them and to put on a hospital robe. Most facilities will provide secure lockers for you to place your belongings in during the exam.
The exam room itself is laid out much like a recording studio. There is a large room containing all the MRI equipment and a smaller room separated by large windows that holds the controls.
A tech will lead you in to the room and get you situated in the machine. You lie on a sliding table that slides in to what looks like a giant metal donut. At this point they will likely offer you either headphones to listen to the radio or earplugs.
The MRI machine is very loud. You’ll definitely want the earplugs or headphones to drown it out.
Once you’re situated in the machine the tech will run a series of exams, taking between about 30 seconds and about 5 minutes. These exams should total about 30 minutes.
In my case my doctor had the pictures a couple of hours after my exam. He called me and cofirmed that i had indeed torn my acl. Additionally theres some tearing in my miniscus and some bruising on the bone, but nothing too out of the ordinary.
The first step on the timeline for your ACL reconstruction is the diagnosis. You had an injury, you’re fearing the worst and now it’s time to get a professional opinion.
If it’s the first time you’ve damaged the anterior cruciate ligament you’ll probably end up either at the emergency room or your primary physician’s office. Once they suspect a ligament injury in your in your knee the doctors will probably suggest that you schedule an appointment with an orthopedic surgeon to get an official diagnosis.
Those of us who who’ve done this before (acl revision patients) will probably call our orthopedic surgeon directly to get the knee looked at.
I fell squarely in to this second category. After a restless night worrying about my knee I woke up feeling quite confident that I’d torn my ACL again, as such i wanted to get right in to see my surgeon.
When you get to your surgeon’s office you’ll have to fill out the requisite paper work and wait until someone leads you to an exam room. Here they’ll ask you to put on a pair of those horrible paper shorts, unless you thought ahead to bring some athletic shorts. The doctor needs good access to your knee for the exam.
After asking you some questions about your history and the circumstances of your accident the doctor will likely have you lie back on the exam table while they move your leg in all directions and observe the joint. They may do the same to your ‘good’ knee to compare the two.
In my case this part the exam was very quick. Within moments the doctor was able to confim my suspicions, but he then spent a few minutes thoroughly examining my knee.
After this exam the doctor may ask to have some pictures taken of the joint. In my exams that’s usually meant they took 3-4 x-rays to cover all angles of the knee. It is my understanding that these pictures don’t really show the ligament but serve more to give the doctor an idea of the condition of the bone.
The width of the tunnels through which the ACL passes are of particular importance to a revision patient. Apparently the tunnels grow in width with each surgery and at some point it is necessary to graft some additional bone into those tunnels to make the knee stable.
My doctor says that my tunnels have increased in size but that i can get away with another allograft (cadaver tendon) if we go up a size from my previous one.
After examining the x-rays with you the doctor will more than likely suggest an MRI to confirm the diagnosis. And that will be the topic of my next post!
I was walking across a wet dance floor at christmas party held on a rainy Seattle night when suddenly I slipped, i fell and i felt a pop. The next morning the knee was dramatically swollen and my range of motion was severely limited and I knew i’d done it again. For the third time I’d torn my ACL.
When i was able to get an appointment with the surgeon who’d performed my previous acl reconstruction it took seconds for him to confirm my suspicions. Today I had an MRI and heard back from the doctor. The pictures make it official, my ACL is torn again and it needs to be fixed.
The most frustrating part to me is that i had done a lot to make sure this wouldn’t happen again. I’ve lost 25 lbs to reduce pressure on my joints, regularly practicing yoga to maintain my flexibility and riding my bicycle frequently to keep my muscles strong. The night i injured myself i had chosen not to enter a bike race where i feared i could injure myself but instead worked the relative safety of the finish line. Apparently all that was not enough and this freak accident was all it took for me to re-injure.
This blog is a silver lining. By chronicling my experiences here i hope to help some others through the process of acl surgery. Being my third time through this I’m starting to get the hang of things and i’m hoping my recovery this time will be the best yet.
If you haven’t heard the news, ACL tears are genetic or at least, predisposition to tears is. You can find the study here, published in the British Journal of Sports Medicine: http://bjsm.bmj.com/content/44/12/848.abstract
or if you prefer, it is discussed in the New York Times here:
http://well.blogs.nytimes.com/2010/09/29/phys-ed-are-bad-knees-in-our-genes/?scp=1&sq=acl&st=cse
Its about female twins, but the data has implications for everyone. Basically, if you are like me and have really flexible knees, it could have contributed to your ACL tear (or in my case, both my ACL tears). If you are like Henry, with a mother and father who tore their ACLs, then it is just another thing you inherited from your parents. My parents never tore their ACLs, though my aunt did (and she opted, instead of surgery, to never do any strenuous activity ever again! – Really!).
But, like most genetic traits, flexible joints is likely pleiotropic say the authors of the study, meaning that lots of genes contribute to that trait, not just one or two. Regardless, next time you see your parents, you could let them know what they did to you 
Or in my case, fear for my children
Henry on Sahale Arm in Washington's North Cascades, with a functioning ACL
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