Saturday, January 12, 2013

change of plans

I went to a different doctor yesterday for a second opinion.  He earned a fellowship from the renowned Steadman Clinic.  Both docs are most excellent, and have both successfully treated personal friends so I have nothing but good things to say about both.  However, I have decided to switch to the second doc, because I simply feel that he is a better fit for me.
He agreed that I need surgery to fix my issue, but his approach is different to the first doc's plan, which was quite educational to me.  I had no idea that my issue, a type of Chondromalacia, had multiple surgery strategies. I figured there was one way to fix things.

Chondromalacia is due to an irritation of the undersurface of the kneecap. The undersurface of the kneecap, or patella, is covered with a layer of smooth cartilage. This cartilage normally glides effortlessly across the knee during bending of the joint. However, in some individuals, the kneecap tends to rub against one side of the knee joint, and the cartilage surface become irritated, and knee pain is the result. 
This image shows the issue decently well, 
but mine issue is more towards the middle of the indentation ( in the trochlear groove).

Here are the differences in their surgeries:

Doc #1: 3 options.  a)make a hole in problem area, take a piece of bone (think wine cork) from other part of femur, and plug the hole with the cork.  b) if the problem is larger, plug the hole with multiple corks. c) if the problem area is really large, add metal to fill the hole.  We're talking about 1 cm piece or so, but it's still metal.

Doc #2:  Dr McDonald's plan has 2 options:  a) scrape the top of the excess cartilage off with a pick (think dentist scraping plaque).  If he can smooth it out and the below area looks healthy, we're done.  b) If it's not healthy, then he will scrape down into the problem area with the same pick, and and poke holes.  The strategy here is to promote new cartilage to grow back to fix / plug the hole organically.

Dr McDonald says that a) has a 90% success rate, and b) has an 80% success rate.  I am satisfied with those odds.  But what if I end up in the 10 or 20% club?  That means my bones do not heal themselves on their own very well anymore. (guess I'm old).  So, first he gives me a shot of some liquid that promotes growth of the cartilage, in addition to lubrication agent, and we see if that fixes things.  If it doesn't, then I get a shot every 6 to 12 months (depending on need) and say good bye to my dreams of running more than 13-15 miles at a time.  I can live with that, as honestly, that's a minor issue in life.  There's more to life than running over 15 miles, like kayaking and rowing. (But not cycling, i am just not interested in that.)

Rehabilitation?  We'll cover that topic when we reach that point.

Prior to my second opinion, I was never quite at peace with what I was about to do to myself, but now I am.

Wish me luck as I go in for surgery on Thursday, Jan 17th at 6am.

1 comment:

Muz said...

I wish you Luck Mike. Those are pretty good odds.