"When it Comes to Severe Pain, Doctors Still Have Much to Learn."

Jane Brody, who writes for the New York Times, has a column that runs on Tuesdays in the Science Times section. In 2005, at 63 years of age, she had both her knees replaced, and subsequently wrote about her experiences dealing with the pain, and the lack of pain medication provided by her doctors. I remember reading these articles at the time, and wondering how anyone as well-prepared, knowledgeable, and well connected as she must be within both the medical field and the newspaper/publishing industry, could have had the experience she did. How could she NOT have been able to find the relief she needed, and if someone in her position can't do it, how can any old (or young) ordinary person? Of course, that was 2005, and the entire process has come a long way since then, including pain relief.....I hope. All conversations and indications I have from the various doctors/seminars I have attended have indicated that the medical field now understands that the only way for a patient to be able to get the best outcome, is to be able to tolerate the pain during rehab, and the only way for that to happen is with the proper medications. At least, I hope this is the case. Here are the articles; they are worth reading.

A New Set of Knees Comes at a Price

When it Comes to Severe Pain, Doctors Still Have Much to Learn

Three Years Later: Knees Made for Dancing

Thirteen days and counting.......

I play tennis on a 4.0 women's team that plays out of Ft. King in Ocala. Three of us live here at Harbor Hills and drive together to the matches. It is a great bunch of ladies, and we have a good time together. As the newbie on the team, they have made me feel very much a part of things.

We started the season with a full roster, but we've been dropping like flies, and now I'm on my last two matches before my surgery. As the surgery gets closer, I am more aware of how life is going to change, and how much I will miss the tennis and all of the activities that revolve around tennis, both with Bill and me, since we play tennis together a lot, as well as with my tennis teams.

Although I am hesitant to play on this knee competitively, the brace is still keeping me on the court, and a live body, even a gimpy one, is better than none. So we travelled together today to Gainesville to play our match. I left the house at 7:10 this morning (yuk!). I am a morning person in that I have an internal alarm that wakes me up early.....I'm just not ready to be good company then. But, off we went. We played our five doubles positions, and won three of them, so we won the day, and my partner and I won as well. It's always good to have a partner who can run, and it is also gratifying to win when you are not at your best, and to have a partner who supports you even when you don't get to that drop shot......again. Then, the celebratory team luncheon at a local Gainesville pub, where some of us have been known to have a beer with lunch, and on to the long drive home. It's a full day.

I find, though, that the tennis takes its toll on the knee, and the rest of the afternoon is spent in less than productive fashion. (Nap, anyone?)

I was looking at the Florida Health Finder site that compares hospitals, and I decided to compare three hospitals: Jupiter Medical Center, which is in Palm Beach county where we lived for many years; Leesburg Regional Medical Center, where I am going in 2 weeks; and Largo Medical Center, where several tennis friends have gone for partial knees and/or arthroscopic surgery. The results were interesting.

The category was Full or Partial Knee Replacement; The age group was Seniors (65+); the time period was calendar year, 2009.

Hosp. # procedures $ Low $High length of stay

JMC 200 63,029 75,477 4.1 days

Largo       936 34,095 53,951 2.5

Leesbg 353 36,339 42,471 3.3

A couple of things pop out at you. One, the cost for the surgery in Palm Beach County vs. the cost in Leesburg and Largo, but no surprise there, really, since PBC is an expensive place to live. Add to that the longer stay, which puzzles me, and that also helps explain the higher costs.

Two, the number of procedures in Largo far exceeds the others (and is the highest of all the hospitals in Florida, also). The length of stay is also considerably shorter.

I have been to two of the seminars by the Largo group, and was put off by the degree of the marketing they do, including referring to the knee replacements as "resurfacing," and the selling of the amenities at the facility. In addition, at the end of the seminars the presenters walk around the room with cell phones dialed into the appointment desk so that participants can make an appointment on the spot. This was a bit of a hard sell, I thought. In addition, they provided pages and pages of references to call. The interesting thing to me was that 90% of the references had partials, not full, which probably accounts for the lower length of stay.

I did not see a doctor at Largo; the conclusions I have drawn come from the seminars and the statistics.

I also looked at the numbers for all ages, not just seniors. An additional category was added: 15 day readmission. Largo's, at 1.77%, was the lowest of the 3 by far. Jupiter was highest with 3.12%, and Leesburg next with 2.76%. My only thought on this is that the rate for Largo is low because PKR are a lesser procedure in the first place.

Research

Over the past few weeks, I've come across some websites that are very useful, and some not so. Want to watch a live TKR? Truth be told, I didn't make it through it all. I always thought one's imagination to be worse than reality, but I'm not so sure about that anymore. However, watching a simulation is easier on the eyes and stomach.

Want to see if your doctor has operated on the wrong leg? Click here.

The Florida Department of Health website has licensing information.

I tried to find information on infection rates at hospitals. Florida Healthfinder has information on all Florida hospitals, but not on infection rates. The information it does offer is useful, though. I did find some infection information on the Consumer's Union/Health link. I paid $4.95 to access the information for one month, only to find Leesburg Hospital has not yet been rated, but the information for those hospitals that have been rated is pretty good.

TKR minus 17 days

Rather than jumping off the deep end as I did after my first doctor's appointment, I waited three days for it all to sink in, while both Bill and I continued to talk to people about their experiences with doctors. It's amazing the things you can find out from networking; doors are opened that you didn't even know existed, and the list of questions to ask becomes longer, just by drawing from other people's experiences.

For instance, Bill went to the Driver's License Office to renew his license (an interesting procedure when you are 81, but that's another story.) While he was there he mentioned to the lady helping him that his wife was having a knee operation. As it happens, she managed a PT facility in The Villages for ten years, and has brought her mother and her sister to the doctor we have decided to use, Dr. Kerina, for several surgeries. She has known him through her job for many years and thinks highly of him as a person and as a physician/surgeon.

So, the surgery is November 8, 2010 at Leesburg Regional Medical Center, and Dr. Jeffrey Kerina will perform the operation. He is the first surgeon we visited, but I feel better having taken the step back and visited at least one other doctor. We feel good about this decision, and now that the decision is made, I'm anxious to get it done.

Doctor Visit #2

The past 3 years, prior to the move to Harbor Hills, we lived in Homosassa. I had an orthopedist there to whom I went periodically for cortisone shots. Like the orthopedist before him in Palm Beach County, he recognized that I needed a knee replacement eventually, and when I was ready, I would come back. In the meantime, though, he kept me on the court with cortisone shots, and then THE BRACE.

So Bill and I paid Dr. Petrella a visit. He has done the knee replacements on several people we know, including a tennis friend whose husband is an orthopedist in Citrus County who also does knee replacements. Any doctor who a doctor respects enough to send his wife to must be good at what he does. Dr. Petrella also did both knees of my tennis partner's husband four or five years ago, and he is playing tennis well.

He took a look; I'm not a candidate for a partial; I need a TKR and one ligament has to be released, which is what Dr. Kerina also had said. Bill and I both felt comfortable with him. He operates out of a hospital in Crystal River, Seven Rivers (see story). So now I have two doctors who we both feel good about. Now what?

Doctor Visit #1

So Bill and I drove down to Leesburg to an appointment with Dr. Kerina. He was recommended by an Orthopaedic doctor who lives in our community, Dr. Claudia Thomas, who is also a partner in the practice. Between the time I made the appointment and the appointment itself, we ran into another resident in our community who had had two surgeries by him and was very pleased. In addition, through my tennis friends, I talked to another person who lives in The Villages who had both knees replaced by him, and who is now back on the tennis court playing at his prior level or better. So far, so good.

So, the consultation went well. Both Bill and I liked him, and felt a high degree of comfort level with him, which is important when someone is going to cut you open. He looked at the xray, and at the knee, and knew immediately what he thought had to be done, which turned out to be more than I thought. The degree of the angle in the knee (severly knock-knee) means that the ACL is probably gone, but the implant itself satisfies that lack. The PCL may need to be replaced, and one ligament has to be released or replaced, and the other ligament is a question mark. On a scale of 1 - 10, it's a 7. Of course the livelihood of any surgeon is surging, but I really knew going in that a TKR was inevitable; I'd been told that for any number of years, but I was still a little shell shocked. We scheduled the surgery for 43 days out.

Now, that is a little fast for me, and for Bill. We are both people who do not make spontaneous decisions. So, once over my shell shock (two days later), I postponed the surgery in order to see one or two more doctors. Of course I also got some input from some knowledgeable people who helped me recognize the value of taking my time in making this major decision.

Decisions, Decisions

My Ad:

Ok, so I've been talking to people, and going to seminars. Bill and I have both been asking people about their experiences. Bill is really good at that, since he can talk to anyone. I, on the other hand, am not so chatty. Anyway, during this process, we listen for what name keeps popping up most frequently. One, in particular, did. I had talked to several people who have had procedures by this doctor, including a tennis player who had both knees replaced by him, and a neighbor who had a hip and shoulder replaced. They speak very highly of him. In addition, our general practitioner recommended him, as well. He is one of 3 appointments I have with surgeons in the next two weeks, but he also happened to be first.