Surgery - My True Story

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 Quick Take Away - What, when, why, where and who.

What Was Done?

      I had arthroscopic surgery done on my right knee Thursday April 26, 2012.

Why Did I Have The Surgery?

      My right knee became swollen and painful about three months before the surgery. Imaging and subsequent diagnosis revealed articular cartilage damage, minor tear in the medial meniscus and a bone spur. An arthroscopic procedure was recommended to smooth the damaged cartilage, trim the meniscus and remove the bone spur. The goal was to restore normal joint function for my particular case in the most expedient way.

Where Did I Have It All Done?

  Surgery* Doctor's Office (downtown) Imaging Physical Theropy

Salt Lake Regional Medical Center
1050 East South Temple
Salt Lake City, UT  84102
(801) 350 - 4111

Comprehensive Orthopedics
      & Sports Medicine
82 South 1100 East #303
Salt Lake City, UT 84102
(801) 533 - 2002
Salt Lake MRI
10696 S. River Front Pkwy
South Jordan, UT 84095
(801) 563- 0333
Salt Lake Regional Medical Center
1050 East South Temple
Salt Lake City, UT  84102
(801) 350 - 4808
Same Day Surgery Center
Dr. Andrew Cooper
Ted Kyle
Ted Sexton

*My anesthesiologist was Dr. Howard. He was also very nice, friendly and comforting.

 

Slide Shows, Thoughts and Conclusions

     Overall my experience with the surgery was a very good one. I found Dr. Cooper to be a competent and caring doctor who was easy to speak with about all aspects of my procedure to include the related concerns I had about surgery. His office is properly staffed with professionals that enjoy helping people like me get through a procedure with a minimum of problems and discomfort. It's obvious from seeing the staff in action that the office is managed well. The hospital struck a good balance between being large enough to have capability but small enough to not lose sight of the human factors. The concept of individualism seems easily lost in a categorical world of business models, statistics and productivity algorithms. Luckily this didn't happen to me. The imaging service was also a well run personal organization and came first in the sequence of events. Images become the doctor's first internal look at your condition so they are important. My MRI ran efficiently and their staff was kind, respectful and pleasant to engage. Physical therapy came last and that too went well. I didn't need as much of it as originally thought, however. The bottom line is I would highly recommend all of these services to a friend or family member.

     The IMPRESSIONS that follow chronicle (in detail) my experience before, during and after my same day surgical procedure. I've included some background on me and my personal reactions just to round things out. I hope it helps someone else locate quality orthopedic medical services quicker than I did. Kissing a lot of toads before finding the prince isn't fun when you have a medical problem in need of resolution. Keep in mind that pain, swelling and a sense of urgency are clearly good motivators to seek medical service but are a minus to mood and the desire to shop around. It's best to know as much as possible before you decide where to go under the knife. Through dumb luck I got a good referral from a friend. It saved me from wasting time which translates directly into reduced aggravation. Dr. Cooper was able to see me in a few weeks which I appreciated. As I write (May 27, 2012) I continue to move through my rehabilitation without problems. There haven't been any surprises to my wallet either. Medical institutions (especially hospitals) are some of the most difficult to deal with when it comes to money, statements and billing. Sales, marketing, profit driven motives and survival tactics are part of any business and we understand that. That said, communication regarding money matters needs to be as clear as possible up front not vague and deceptive after the fact. The doctor's office, imaging service and hospital understood this which means the insurance and financial details have fallen into place correctly. Being able to avoid the battle of the bills is welcome relief. I feel better already!


  Impressions:
 

A Little About Me:

     My name is Scott (57) and I've enjoyed a variety of leisure time sports, sports training and outdoor activities all my life. That said, I can't claim to be really good at any one sport I've engaged in. Instead I've chosen to move around to a lot of different sports, get diverse exposure and be happy with just being OK at what I put myself around. For me, doing sports things transports you into another dimension that's just fun. Learning a new skill and spending the time to get functional at it is rewarding. Throw in the calories you burn doing this stuff and it all adds up to an enjoyable experience. Running, however, is something I've stayed far away from for fear of early knee problems. But if you are using your legs (as one does when skiing or playing racket sports, for example) your hips, knees and ankles are going to experience wear and tear. As for the knees and hips, I guess at some point those of us that remain active later in life just out live our cartilage. Each of us have just so many bends, presses and flexions in our joints before they start showing signs of wear. Sooner or later you're going to see the blue smoke coming out the tailpipe going down hill. In 57 years, the knee surgery presented above is the first joint problem I've ever had. If your knees aren't working properly forget about hiking, running, skiing, biking, racket sports, etc. Over the years I've tried to be careful, stay within reasonable limits, avoid stupid things and move stresses around the body hoping to stay on line and put off joint problems for as long as possible. Fish oil, nine grain diets and glucosamine sulfate get you just so far.

My Right Knee:


Swollen Right Knee
 

Mountain Unicycling
Notice Knee Pads
 

Bad Crash
Through The Pads
 

     I had my right knee surgery on April 26, 2012. Approximately 3 months prior, my knee became swollen for no apparent reason. It would be easier to understand if the swelling was associated with some sort of event. This wasn't the case, however. I'm not an alarmist so I decided to let some time pass hoping this would resolve itself as is sometimes the case. A "let nature take its course" sort of philosophy as it were. As the weeks passed nothing improved and the knee began to hurt. In addition, I felt some clicking and popping within the joint which was worse during periods of limited activity like standing from being seated after a meal. At the gym I was unable to complete several routine leg exercises owing to pain. This drew concern and I knew then that something was wrong which was beyond the body's ability to heal itself. Being somewhat of a stranger in a strange land I had difficulty locating proper medical resources. Several less than optimal visits (more on this later) to area doctors didn't yield anything I was comfortable with. I discussed the situation with several of my friends at the gym and nothing viable surfaced. Beaten, broken, depressed and downhearted I hobbled around for several months before showing up at Comprehensive Orthopedics and Sports Medicine where Dr. Andrew Cooper quickly diagnosed the root problem as articular cartilage damage with the possibility for other issues like a meniscus tear. He explained three possible surgical options to include 1) basic scoping, 2) cartilage regrowth and 3) cartilage transplant. Option 2 involves drilling small holes in the bone and allowing it to bleed thus creating replacement cartilage. This option was ruled out because the area of damage was too big. Option 3 (considered somewhat major surgery) involves taking plugs of good cartilage and transplanting them to the damaged area. This option wasn't ruled out but best left on the table as an option for later on if needed. Dr. Cooper recommended option 1 given it was the simplest procedure with the quickest recovery time. He's done thousands of these surgeries and felt I would get the best overall benefit from this procedure. I was perfectly comfortable following his advice.

     As mentioned previously, I've never had any troubles with any of my joints. I've also never been 57 years old either. Aside from aging, what was puzzling is my left knee has seen far more usage owing to years of trials riding I've done. My left leg is my "chocolate" foot meaning it gets all the pressure during moves. Dr. Cooper felt that perhaps an old sports injury might have damaged the cartilage in my right knee leaving it more vulnerable to tearing. Just his professional opinion which turned out to be spot on. It didn't hit me while I was in the doctor's office but his observation got me to thinking. Searching my memory I did crash about 10 years ago on a mountain unicycling run. I was pitched off the front of the mountain unicycle coming down a hill. Running out the fall, I stumbled and slammed my knee into a sharp rock as I fell (see photo at left). Luckily I had pads on with polycarbonate armor. I hit so hard the armor bent and the resultant force split my knee open. Although I can't say for sure, it's entirely possible this did some cartilage damage and set the stage for problems later on. Out of concern I did have a recent MRI done on my left knee and it showed only very minor cartilage damage. So minor that no surgical procedure is indicated at this time. If I manage that joint (and the right one too) properly I may never have any problems. I can only hope for the best outcome at this point. There is no reason to borrow trouble.

Staying In Shape:

     I do try to keep my weight down and train the muscle groups that keep the joints tight and supported. This helps me enjoy the activities I like in the best possible way. Weight training also helps keep bone density loss to a minimum. The goal is to stay active for as long as possible and avoid problems (and injuries) that take you out of the game. Sitting around isn't something I deal with particularly well. Proper training is an important part of avoiding problems. Especially as you get older. I think I've done a good job of doing my physical homework so to speak. Being active, however, has its down sides too. One of which means placing more wear and tear on the joints. Of interest is both my parents never did anything really physical beyond going up and down stairs and walking to and from the car. Both made it to almost 90 years old and never had any knee or joint problems. In fact, they both enjoyed generally good health. My two older brothers of 5 and 10 years my senior also have not had any joint problems. For me staying away from sports activities isn't an option so I'm left with balancing, calibration and scaling considerations. It's work in progress and I'm learning what I can do, how much of it is smart and when to take a rest. Time will tell how well I'm doing. Moving forward, I remain positive, continue to learn things and feel I have many more active years left to enjoy all sorts of activities. At this stage in my life, I don't need to beat anyone, be the best guy or make any athletic statements. Learning how to identify the smart risks, conserve physical resources and maximizing enjoyment are the most important ingredients for me. Your mileage may vary, of course.

Finding A Good Doctor:

   
     Not being a Utah resident and having nothing but the generic research tools available, locating a doctor (and hospital) was the hard part for me. And no amount of

Dr. Cooper checks my knee two weeks after surgery. He too is a sports guy and knows first hand how activities affect joints. Although I'm healing quickly, he reminds me to be careful for the next four weeks.

planning or research can replace good old fashioned dumb luck. And that is exactly what happened. In fact, it was the "dumb luck" aspect of my search efforts that got me thinking about writing this article. The dumb luck was nothing more than a friend being kind enough to recommend Dr. Cooper to me during an off chance meeting. After a few bomb outs with other doctors, the recommendation couldn't have come at a better time. It saved me the time I just didn't feel like spending anymore shopping around. After visiting Dr. Cooper, getting a diagnosis and going through the surgery I said to myself that others out there should know what I found. (It's also important to mention that I don't get paid for this or receive any special treatment or get price breaks.) Orthopedic medicine is rated highly in Salt Lake City Utah owing to area universities, the 2002 Olympic Games, competition among doctors, world renown ski resorts and general demand for sports medicine to name just a few factors. Utah is also continuing to move forward with its Utah Health Exchange program which it sees as more of a free market alternative (see #1 in reference below). Competition is a good thing as it helps keep doctors directly in touch with the patients. Those doctors that fall out of touch with their patients and/or can't provide good medicine at a reasonable price simply won't earn as good a living. But it isn't all about money either. Doctors deal with human beings and there needs to be a caring factor that transcends money. Somewhere that perfect balance needs to be struck. I'm sure many very good orthopedic doctors exist that do well balancing their practices. As a patient that needs surgery you don't want to deal with a market of doctors. You just want to find one that cares, connects and has the business acumen to find a way through the complex health care system. I was lucky to find Dr. Cooper as both he and his staff hit all the high marks I was expecting.
Additional Reading Reference
1) Utah's Health Reform The Economist May 26th - June 1st 2012 Page 30
2) Squeezing Out The Doctor The Economist June 2nd - June 8th 2012 Page 29
3) The Medical Workforce The Economist June 2nd - June 8th 2012 Page 30

Going Under The Knife:

     On the 26th of April at 12 noon I showed up at Salt Lake Regional Medical Center to be admitted into their same day surgery unit. You enter your name into a kiosk and soon thereafter someone calls you into one of three admitting booths. There you meet with a hospital agent and go through the myriad of paperwork required to admit you for same day surgery. Being asked if your living will is in place doesn't inspire comfort but it's all part of normal hospital procedures. Nothing in my admitting procedure was out of line or odd. Standard operating procedure as they say. It had been some 25 years since I went under general anesthesia for surgery so I was your typical terrified and skeptical patient. I must say the hospital staff responded well to this and provided a comforting hand. On the admitting side, everything was clearly explained and efficiently handled. Once you get through the admitting process (about 45 minutes in my case) you take a seat and wait for a nurse to escort you into the surgery preparation area. She came promptly and was very pleasant. The preparation area consisted of multiple small rooms each containing a bed on wheels. I was one of about 9 surgeries scheduled for Dr. Cooper that day (Thursday) and my number was due up at around 2pm. You can't eat or drink anything after midnight the previous day so your system is a little off camber. This step is necessary to avoid complications. Once inside the room, you have privacy to change into a gown and also enough space for one or two guests. Jeannie (my wife) came along to keep me company and provide moral support. Both were welcomed and helped keep my mind off things to come.

     Next two young fellows came in to provide assistance. One took care of shaving the hair off my knee to include a bit above and below the surgical site. Everything was clearly explained to me and handled with care. In other words, no surprises. That theme continued throughout my procedure. A nurse then entered to check vital signs and install the IV drip into my left forearm. My veins are good so this went well. I had both water and saline bags setup on the hook. It wasn't long before the water started to make its way through me and I was glad the IV system was on wheels and the bathroom was right across the hall. I was the next to last surgery scheduled for that day and I didn't get moving until around 4:30pm. The person that coined the term "patient" was clearly a genius. In fairness to the doctor, it's impossible to schedule surgeries that fit precisely on a time table. Each one is unique and most require more time than expected. And no one wants to get the bum's rush in the OR. As for me, I figured the experience was going to take the whole day so I was prepared to wait as required. Waiting isn't easy but when you are asked to do it it's best to be gracious about it and understand there are good reasons. While I was waiting Dr. Buck visited me with some routine questions and the nurse continued to come by to see how I was doing and give me an update on the schedule. All continued to go well and I was as relaxed as anyone can be awaiting surgery.

     Dr. Cooper had two operating rooms working on that day. Clearly he was very busy. That said, he was kind enough to stop into my room and see how I was doing. We spent a few minutes chatting, he signed my right knee and then he was off to the OR again. For me it was good to see a familiar face and know the main guy was on the scene. Soon Dr. Howard came by to go over the anesthesia and how that all worked. He too was very nice and had a great sense of humor. I do a lot of teasing and make many off the cuff remarks. If you don't have a sense of humor I'm probably not the guy you want to be around. Needless to say Dr. Howard and I connected well. He and Dr. Cooper are friends and I like that too. It's better than just two functional roles working under routine procedures. Dr. Howard questioned me carefully about not having any food after midnight. He mentioned stomach juices refluxing up into the lungs can cause a serious infection. I do suffer from some mild acid reflux from time to time but wasn't experiencing any that day. To be on the safe side Dr. Howard told me he would install a breathing tube. That to be done after I was put out. I had no ill effects (sore throat) from this whatsoever so I gather it was taken care of delicately. As mentioned, I was put out (25 years ago) and had bad nausea during recovery. He said he would add something into my IV to help avoid this from happening. It worked because I didn't have any problems.

 

About 24 hours after surgery I'm hobbling in for snacks and drinks. My post operative exam went well.

     It was leaning hard on about 4pm and I knew my number was coming due soon. And sure enough the operating room nurse came in to say, "OK it's your turn and it's time to go." A jovial woman with a firm, confident and comforting style of dealing with me. We exchanged a few jokes before she released the brakes on my bed with some confusion and then off it went. It was funny because there are several different beds and the brake levers aren't in the same position. Things like this open the door for humor and I just couldn't resist a few competency remarks. Flat on my back, the ceiling lights began whizzing by as I went through the red doors and down one hallway making a right turn then down another hallway then right into the OR. Along the way, she mention I will be getting put out quickly. No problems with that. The OR was cold as I was told ahead of time. I slid my butt off the roller bed negotiating a small gap and onto the operating table. It was a bit hard (the bed) but not uncomfortable. Looking around I saw a large flat screen TV with a test pattern on it, OR lights and a bunch of equipment. Dr. Howard said he was going to give me something to make me feel good. Within seconds the room started spinning like a top. The next thing I knew I woke up in the recovery area with absolutely no sense my surgery had been completed and that I had been out for about an hour and 15 minutes. As I returned to a semi-conscience state, a young lady by the name of Mallory (recovery room nurse) told me all went well and to just relax for now. I remember telling her she was a very nice girl. For a few minutes I wasn't sure if I had somehow become part of a dream.

     Actually what really happens is you are moved into a post surgery recovery status while still unconscience. Vital signs are monitored as you are slowly brought out of the anesthesia. Obviously this is designed to avoid complications and if any develop medical resources are immediately available to address the situation. A TV monitor displays patient status for friends and family as color coded categories (waiting surgery, in surgery, recovery, released). Jeannie waited in the surgical waiting room when I went into surgery. When my surgery was done, Dr. Cooper met with Jeannie to provide a review on what had happened to include photos of what the arthroscopic camera had recorded (see slide show above). In my case, the news was all good. When the recovery nurse decided I was awake enough, she called Jeannie on the house phone to notify her that I could receive visitors. Once Jeannie arrived, it took me another 30-45 minutes before I was able to make complete sense and comprehend my surroundings. Once completely conscience, I began to feel some pain in my knee. Mallory brought me two pudding cups to eat and a diet coke. I was instructed to take a Percocet tablet before the pain became too intense. As for the pain, it never got too intense and considering I had just returned from surgery I remained surprisingly comfortable. Soon I was able to get up and move around on crutches with reasonable facility. A bathroom stop was in order and by about 7:00p I was out the door and heading home.

    Actually Jeannie and I didn't go home. We stopped at the Sports Mall (local fitness center) to update my friends on what had happened. I hobbled around on the crutches and was careful to not put any pressure on my knee. My knee was sore but I never had any really bad pain. I was given two pain medications but used very little of it. Truth be known, it just didn't hurt that much. After moving around and going up a flight of stairs I felt a touch of nausea but nothing really bad. I sat down, relaxed and it quickly went away. For a few seconds I thought I was going to toss my cookies over the second floor railing but thankfully it didn't come to that. Following our visit to the Sports Mall we went out for a nice dinner which tasted pretty good after not having any food for almost 20 hours. The food caused no problems whatsoever. Other than my knee being stiff, swollen and quite tender I felt reasonably comfortable. Overall comfort levels were much better than expected. That night's sleep wasn't bad either. Some tossing and turning to get comfortable but all of that is understandable.

The Next Day:

Tiff is the young lady that was kind enough to refer me to Dr. Cooper.

     Secondary infection is always a concern and I was required to go back to the doctor's office in 24 hours for an inspection of the incisions. I was given an emergency number to call if I had any problems during the overnight after surgery. With infections, it's important to take action immediately. These can be extremely serious and I'm sure we've all heard the horror stories. Dr. Cooper mentioned to me he is adament about following proper procedures to minimize the risks of infection before, during and after surgery. In the thousands of surgeries he has performed he recalls only one case of a secondary infection. And that came from a patient that got his incisions wet before the two week dry period. In other words, the patient didn't listen to the doctor's explicit instructions about avoiding getting your incisions wet before they have a chance to heal. As for me, I had absolutely no problems with any of that. I also followed the instructions and then some by being extra careful with my two incisions and the surgical site. 3M makes a waterproof bandage that was large enough to cover what needed to stay dry. I used these with good results during showers. A doctor and patient form a team and if you aren't going to do your part the team goals then break down. This is obvious but some out there just don't seem to understand such a basic concept.

Days Following:

     As knee surgeries go the one I had is at the lower end of the severity spectrum. That means you can return to normal activities (within reason) sooner than those having a major rebuild, replacement or reconstruction that involves mending of tendons/ligaments. By Sunday (72 hours later) I was able to walk without crutches with little to no pain. It wasn't quite a normal walk because I still couldn't bend my knee back all the way. As days past I began to gain more bending movement with less pain. My goal was to keep the joint moving (within reason) and do the prescribed icing to keep swelling down. For me, sitting around is just bad medicine so I tried to avoid too much of that. Joints are made to be moved and used but also require rest when coming back from surgery. The trick is to stay in touch with your body and know what the best activity/rest balance is. If you go overboard then you actually impede the healing process which leads to regression and possible complications. Even if a joint feels good and capable, heed the fact that deeper healing is going on. I didn't push beyond reasonable limits. If you mess things up through irresponsible (and ignorant) behavior it won't make the doctor very happy when he takes a look at the damage. I went into this surgery in reasonably good shape and I think that helps you get back on your feet quickly. Like I said, you and the doctor form a team so it's important to help the doctor put his best foot forward. Ideally that should start long before needing any surgery by just staying in good shape. In the real world, however, it doesn't always happen like this. We are all doing the best we can.

Conclusions And Parting Thoughts:

Tiff (short for Tiffany) enjoys the outdoors now back 100% from knee and ankle surgery.

     As the terrified patient type it was difficult for me to visit the doctor and have him take a look. I sort of knew I'd need surgery. With age comes the discipline to rise above subconscience denial and putting things off. After bombing out with a big name Park City doctor, I decided to suck it up one last time. The Dr. Cooper referral couldn't have come at a better time. Many thanks to Tiff for this. Once in the examining room with Dr. Cooper, I knew quickly things would go smoothly from here on. I remember teasing him by saying, "Doc you're hired." I base a lot of my decision making on gut feelings and I just felt good about him, his staff, the diagnosis, explanations, surgical options and his experience. For me a doctor's bedside manner is really important and he has all of that going and more. I don't feel comfortable with someone I can't connect with or that can't connect with me for whatever reason. Cooper's office, the imaging service and the hospital are also wallet friendly which is HUGE. Money is important and you want to have a basic idea of what things will cost. As I write, there have been no unpleasant financial surprises which means one less thing to worry about while you are getting better. Sadly this is the exception rather than the rule. As a detail oriented person I'm very critical of things and expect that professionals know their jobs at all levels. And when you do expect things to run smoothly I don't like being treated like the fussy customer. As for my recent surgical procedure, everyone hit the high marks I was hoping for. No one could ask for anymore than a fair, honest and clean deal. Everyone did their part. A BIG thanks to Dr. Cooper and all those I had dealings with. Keep up the good work!

     It's no secret that America's health care system (if you can even call it that) is in a state of complete disarray. I've hassled over more bills/statements than one person should. I've also received less than professional care in too many cases from supposedly qualified doctors. A complete treatment of this is well beyond the scope of this article so I'll leave you with some parting thoughts. First, please read the articles in the reference box above if you can. There is some enlightening information presented within them. Medicine is a business and those involved need to be able to earn a living, keep up with technology and provide the best possible service. The organizational entities (hospitals and doctor's offices to name a few) also need to turn a profit or they can't survive. All of it takes money. Today, health care management organizations come between patients paying for medical services directly. This adds a third party to the equation with its own ideas about costs, coverage, categories and what's considered appropriate. Those ideas don't always serve the doctor and patient well. From my seat it's a complete mess of red tape, computer systems, claims processors, etc. that adds up to billions of dollars of overhead annually. Plus it seems no one understands how it all works. From the patient's point of view it leaves you uncertain about just what to expect, especially in the area of financial matters. Doctors too, endure their share of frustration by being pulled away from practicing medicine (which they do best) and into corporate strategy meetings.

     Getting through the current medical system isn't an easy task for anyone. I must say Dr. Cooper's office and the hospital did a good job of making a complex system as easy for the patient to manage as possible. It's something I really appreciated more than I can express here in words. When it comes to doctors, you want the best and brightest ones practicing medicine. Especially surgeons who need the precision of a Swiss watch maker's hands to perform what to me is nothing short of a miracle. At its most basic level the system needs to ensure this. I hope the Dr. Coopers among us can somehow lead us out of the weirdness in the health care system. I hope as the years tick away he continues to be rewarded for excellence in his field and not be ground down by excessive red tape, bureaucracy and over regulation. I felt compelled to tell my story here with the hope it provides a meaningful reward (one that transcends business) to help keep the goodness flowing for others in need like me. Positive change will come slowly through each good doctor and patient experience. In a world of negatives, people need to know there's a lot of good going on. I'm healing on schedule and slowly getting back to my activities. Thanks for reading and let's all get well soon.

Rev 1 - 6/6/2012