The beginning takes the longest

At last, here we go. The summary: Dr. Steadman will be performing my surgery tomorrow morning. He indicated an 85% chance I would get better, with a 60% chance that another surgery would be needed. Extension of 5 and flexion of 120 would be very successful and that would be enough to bike and run, and then we'd go from there. Should be overnight outpatient, and pleased I was staying a month for PT. That's the bullet. Everything else below is just details, but heck, if you've read this far...

10:15 Arrive at the Vail Valley Medical center for Steadman-Hawkins clinic. Steadman's office is on the third floor. His seems to be the only clinic directly in the hospital. Walking towards his office is a little wacky - there are framed pictures of lots of sports folks, with signatures and notes written on them. Bruce Smith, the linebacker for the NY Giants, and Moses Alou were the main names that stuck out, but there are plenty of skiers and others. Check in was quick since I'd already faxed the basic info. Filled out a research form (pain is 1-10) for them to include me in their research stats. Also filled out anethesia paperwork since I was tenative for surgery.

10:35 Surprised that Andrea, one the nurses, came by so quickly near my appointed time. She asked me a few questions about my history, and wrote a few notes. Shared my newly-created binder with all my notes, and she asked for the post-op notes, and MRI notes, and I also gave her my update from Angela. She shuffled me down to x-ray for two more pictures, one from the back of the knee and one of my lower body. They had just installed a digital MRI system, so 2 minutes after my MRI, they had the 'digital films' displayed on the monitor in my room!

11:00 One of Steadman's fellows, Al Stubbs, entered. Nice guy (I think his bio is on Steadman's site). Asked about my history, and then proceeded to skim through my post-op and MRI reports; I pointed out that I had more range on the table during the MUA than the debridement two months later, and he wrote that down. He then checked my breathing. He then performed a neurological exam (Lissa knew that, not me) This was basically a quick game of SimonSays - follow my finger with your eyes, put your hands like this, thumbs like this, arms, elbows like this. It was pretty funny to watch, I suspect. He mostly listened this entire time. I'm guessing after some thought they probably aren't supposed to diagnose to much.

He then proceeded to do some flexion, extension and other stuff with my good leg and then switched to the left. Indicated my kneecap was definitely locked down and it had about 20-60 range with a little pain. I indicated that I had some other opinions as well and he asked what they said, and I quickly ran through the opinions of the other 4 doctors (Schoch, original OS - can't do much more; Kilbride, could remove tissue but no directly experience with artho and rehab; Burns, who said see Steadman, and Windler, who said wait a month). He asked where were staying and upon hearing Avon mentioned the PT facility in Beaver Creek instead of or addition to the one in Vail. He said Steadman likes people to stay a week, but if you can stay longer, that's great, becuase the PT's are available 365 days a year. [Lissa then mentioned how much Angela and Adam have done]

I asked about pain medication, and he mentioned aspirin and another anti-inflamatory for about a week after the surgery and other pain medication as needed, but seemed like taking pain meds specifically for PT was unlikely, although everyone is different. You're really trying to get everything you can under anethesia and then keep that once you're awake. He then said he's review the info and Steadman would stop by soon.

12:15 Steadman arrives. He's a big guy, probably 6' 4", with a deep voice. Definitely a grandfather figure. He also asked about the history, and I shared a little with him as well. He said it was a difficult case, and a normal OS would see this probably once every 5 years or so, whereas he sees them frequently. Based on the surgical techniques and rehab protocols, there's about an 85% chance of good improvement, and a 0.5% chance it will get worse. When things are this bad, sometimes more than one surgery is needed. He then proceeded to play with my knee for a bit. I asked him if he was able to determine what the problem was, and he said there was significant scarring between the patella and the tibia. The fat pad that normally is fluid and flexible had been scared with dense scar tissue. He said he'd remove that, as well as some tissue that might have formed above it. Depending on the extension after that procedure (a Lysis of adhension, LOA), he might consider, and would expect at this point, to also do an AIR and chonoicaplasty (sp?) on the back of the knee. The LOA would be arthoscopic but the c-plasty would be open - this would entail opening up the back of the knee and [doing something] to help the knee straighten. If my knee was at 10 degrees or lower, he wouldn't consider it, but becuase my knee has not been straight for so long it forgots how. He'd do this on the outside of the knee and potentially on the inside as well.

This would be a step-wise approach, so depending on the result of each step, the next may or may not be done, although he thought all might be needed at this point. The bone calcificaiton is not normally an issue, but we'd deal with it on a subsequent surgery. Yep, he said some require three surgeries or more, but another was possible based on where I was [of course, depending on what I wanted] It would be about 3-6 months down the line. He said it was flexible since we mentioned we have a wedding in a few months :)

He's from Sherman, Texas, where Austin College is, where Lissa went for a year, so they mentioned that. He also volunteered he's an Aggie, but I said that wasn't a reason to not move forward with the surgery. And that's the end of the office visit. Tune in later for the details on the pre-op steps!