Monday, June 17, 2013

Arthroscopy Pre-op

I think it was a novel enough experience that I should blog about it. The last time I had an operation was a surgery on my finger. And it was quite a lousy experience, considering I wanted to punch someone with my other arm. -_-|||  But that's a story for another day...

This time round, I have Dr Richard Diana from Connecticut Orthopaedic Surgery for a surgery on my left knee - a lateral meniscus tear. He is extremely patient, walked me through his diagnosis, the MRI and what he recommends I do and what he was going to do. Answered my queries and concerns about insurance coverage and risks. Wasn't pushy when I said I wanted to give it some thought, since surgery does have its risks, no matter how small the surgery is and also I had to consider other factors like family inaccessibility, staying on the second floor, my schedule etc.

 - Right knee profile -
medial is inner, lateral is outer of the knee and typically blood vessels are in the outer rim of the meniscus
I had my concerns. I read some forums about how some surgeries were done badly, how people still had pain after surgeries and how it was worse than before!! *gasp*

Ultimately, while it took me more than a month to consider, I decided to go ahead. My main rationale was to get it done early, especially when I am still young, fit and healthy. Many of the people who had very dire complaints were of more advanced age or with more sedentary lifestyles. Recovery might come more of a concern later in life, particularly if the tear worsens. This thing has been plaguing me since 16 or so and I think it just broke through a certain threshold when I came to the US. Hence, I thought might as well reduce the risk of further damage now. Also, the university insurance coverage seems to mean I don't have to pay much at all - that eased my financial concerns. The last push factor is second opinions I got from my other doctor friends (a sports medicine doc one of them, thanks A and YM!!) and my friends who have known people who did the surgeries and said they worked well for them. They did caution that the physical therapy is the life-saver for them. I must keep that in mind.

Pre-op, I had an MRI and an X-ray done. X-ray didn't show up anything, but MRI did. I was told that, the tear was not near blood vessels for healing (inner rim of the meniscus; blood vessels on outer). For healing to occur, the tear would have to be sufficiently close to the blood vessels for nutrients and materials brought by the blood to help in the healing process. Alas, the tear would have to be snipped away (menisectomy) instead of being stitched. Finally, I was given a rough idea of the recovery time for a typical person: within a week I would able to limp without crutches, within 2 weeks walk, and within a month jog lightly. I like that. I like knowing my schedule, so I can plan my stuff around it, and putting extra time to buffer.

- Different kinds of tears -
I was imagining mine to be like (d), but when I saw it on screen, it looks like (b), so maybe a combination of both like (c)??
I have tried explaining this to my mum what I think is happening, as lay as possible. I think it makes sense, so I shall try explaining it here too. The (two) menisci act to distribute the force exerted by both the tibia (calf bone) and the femur (thigh bone). So when you have a tear, you experience some form of discomfort when the bone brushes over a tear instead of a smooth fibrocartilage. Snipping away does reduce the size of the meniscus but it beats leaving the tear there. I liken this to a piece of paper. When there is a small partial tear, it is much more likely and easily that the paper will be torn further via that tear, then if a new tear were to start someplace else away from that tear (try with a piece of rough paper). Snipping that tear away will reduce the probability of further damage to the cartilage via that tear. However, it does reduce the cartilage area, hence your cartilage will not as resilient as your original whole cartilage, but to damage it, the impact would have to make a new tear instead of worsening an old one.

Before the surgery, I had to do the routine pre-op within 30 days of the surgery - draw blood to test for cholesterol levels and the likes. Happy to know I was good to go. 12 midnight on the day of the surgery, I was to stop eating and drinking - basically just sleep with no supper and breakfast.

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