Hi y'all

[Gringo]

Oh yes, there is. This little country is dependent upon tourism to a huge extent. They really have nothing to export, except suntans. I have heard that some of the resorts and hotels occupancy are down to half what would normally be expected. Actually, for people in the US and Canada who need a quick tropical fix it's a pretty good deal right now. Only a little over an hour by air from Miami, you can probably get a reservation without much hassle. It's close enough for long weekends, in fact.

I could go on for pages about this bonefishing property we want to build, but I get the feeling that this is a different kind of 'bone' forum..nyuk nyuk nyuk...

On top of the economy, the Brits decided the government down here was so corrupt they just suspended the constitution, kicked out all the ministers, and the Govenor is taking over for the Crown until the next election. It's a hoot. Sometimes living here is like being an extra in an Eddie Murphy movie.

It's a beautiful place, though. And the people are some of the best, albeit a little TOO tolerant of bribes and kickbacks for some. Doesn't bother us. We don't mind the game as long as we know the rules.

 

[Max Wallace]

I would suggest both at once. I had BI-TKR 4 months ago and now can enjoy life again. I had 2 surgeons 1- 2.5 hour surgery and 1 recovery I am glad I got it all done at once.

Good luck!

Max

 

[Gringo]

Well, that was what I wanted to do. My insurance pays for the knee, but they don't pay the round trip airline tickets, the month in a hotel, meals, car rental, etc. I imagine the doc will want to see me again at some point in the future, too. Or maybe not, I don't know. I do know I don't plan to fly back up unless I am having problems.

Anyhow, the OS said that he wanted to get the bad one fixed and me comfortable and happy with it, and then he would do a partial on the other one. I am thinking that he wants me to have one working knee during the rehab because he is going to carve this bad one up pretty good.

But I don't know. This is one of the factors of being so remote. A tradeoff in lifestyle, when it comes to medical care convenience. We are happy to make it.

 

[hurtingbuthopeful]

seeing your blog makes me think I would be happy to make that tradeoff also. You live in paradise... I couldn't even imagine what that must be like. More power to you! You did what most only dream of...

 

[Judles]

Gringo! So great to live the dream! Hope
You get all this figured out in due time!

 

[dw6928]

Jo, back to my original question: doesn't this extraordinary number of 'knees per day' lend itself to factory medicine? A dear friend of mine had his done by a surgeon who does 12+ a day and his after surgery care was dreadful, he never saw the actual surgeon again only surgical assistants and physician assistants. Needless to say, he had nerve damage and was in great distress for more than a year.

 

[Josephine]

Depends upon the surgeon. Most that I know manage to keep a caring attitude towards their patients despite it all. But if you want excellence, this is the way it's obtained. Same as Olympic Athletes, championship golfers and drivers - they get there by doing little else all day, every day.

 

[dw6928]

Let me ask you this then: according to my OS, it is a relatively simple surgery, amongst the most elementary in orthopedic surgery. If this is the case, and I have no reason to doubt him, why does one need a surgeon who does thousands of the same procedure over and over. How could they possibly see patients during rounds or in their offices with that kind of surgical schedule? I do not mean to be argumentative Jo, I am just kind of curious. Thanks, Wayne

 

[Gringo]

I am curious, too. I certainly see what Jo is saying...someone who does that many, constantly, could do one in his sleep. He could do one by feel. Probably in the dark.


But I doubt he would remember your knee, your face, or your name 48 hours later. Is that important? Probably not, in the long term.

 

[dw6928]

I have had both knees replaced last year and have developed a wonderful relationship with my surgeon and am glad not to be a faceless knee. If things go awry who does one see?

 

[Jamie]

If there is a problem with your knee, your surgeon should be the first person you contact.

 

[dw6928]

and if your surgeon is performing thousands of surgeries a year, how is that possible? it leaves no time for office visits I would imagine.

 

[Jamie]

Dw....a good surgeon will have time for aftercare for his or her patients. That would be the first place to call if there is a problem. Unless, of course, the "problem" is more of an emergency....then I would think a trip to the Emergency Room would be wiser if you cannot get to see your surgeon immediately. Are you having a problem or just asking this question in general?

 

[Josephine]

I am curious, too. I certainly see what Jo is saying...someone who does that many, constantly, could do one in his sleep. He could do one by feel. Probably in the dark.

But I doubt he would remember your knee, your face, or your name 48 hours later. Is that important? Probably not, in the long term.

But they do remember! They have prodigious memories. That's why I think they are awesome. I was once reaquainted with a surgeon with whom I had worked 21 years before. I had had no contact with him in the interim but he remembered my name and when I had worked with him!

Plus surgeons can be notoriously 'economical with the truth' when it comes to describing how long something takes or how easy it is! I know times when a surgeon has booked a case on the premise that it would take about 40 mins only to find it took 2 hrs. Of course, he meant that he would take 40 mins which was true but wouldn't make allowances for checking the patient in, anaesthetic administered, prep and draping in the OR, intitial incision, wound closure and dressing and patient's time in recovery.

For instance, when my nephew had surgery for cancer in the neck some years back, the surgeon told his mother it would take about 1½hrs. He went down at 1230pm so she rang the ward at 2pm and found he was still in theatre. It was almost 6pm by the time he arrived on the ward by which time she was distraught, convinced he must have had a serious problem and had had a cardica arrest or something! I had to explain to her the probable timetable was
12.30pm left the ward, taken into preop reception area to be checked and marked
1pm taken into anaesthetic room, anaesthetised, intubated, lines put in and catheterised
2pm taken into theatre, prepped and draped
2.30pm surgeon starts work
4pm surgeon finishes, wound is dressed and anaesthetic reversed, patient extubated
4.30pm taken to recovery
6pm returned to ward.

and if your surgeon is performing thousands of surgeries a year, how is that possible? it leaves no time for office visits I would imagine.

Well, now you're asking! I can't really say but I do know there are many websites, particularly of US surgeons, who are claiming 4-5,000 joint replacements per year. I was just trying to explain one way it could be accomplished.

 

[Gringo]

I gotta admit, this whole catheter concept gives me the willies, too.

 

[Jamie]

Gringo, in the US they are usually put in while you are asleep so you don't even know it takes place. It is removed as soon as possible after surgery. Guys have it easy cuz they can use that little bottle....think how bad it is for us gals afterwards!! Some people aren't able to get out of bed until the day after surgery....at least that's how it was for me. But you're on such nice drugs quite frankly none of it matters much to you. It will be okay!!

 

[Gringo]

Well, the hospital just emailed me back that they have free wireless internet throughout all patient and visitors areas. So at least I can keep up with emails etc.

 

[Simon]

Gringo,

Given your travel issues etc I would have both done at once. I had 2 really bad knees and the OS would prefer to do them one at a time but given that I really did not have a good one he went ahead. The left one was not too much of a problem and only took a little longer than planned. The right one was another story it took about 3 times as long as planned. Because of a previous bone graft, the tibia cracked slightly and he really wanted to put in a implant with a longer stem for stability but time was running out (the anesthesiologist was doing a verbal count down by that point) so they just put a bunch of cement on the break and finished up. I was there at 6:00 am and made it to post op around 12:30 ish (this includes all the preop set up, femoral blocks etc). I had a major problem with nausea and vomiting so I did not make it to the room till about 6 pm. The OS said if he had started on the right he would not have done the left one at that time.
I knew what was going on as I did not use sedation as I had plenty of experience with knee surgeries done without sedation as the OS needed me awake in order to move the knee. I had no problems with this as I like knowing what is going on. I was able to watch the scopes in the previous surgeries and this time watched as the computer did the mapping. I know that I am probably only one of a few who wants to be awake.

Though it would not be my choice, one way to cut down the time is have 2 surgeons working at the same time. There are places that do that.

Even with all these problems things have worked out well for me and I hope they do so for you.

I keep thinking about Jo's numbers and did some checking and to find a surgeon in Vermont that did that many would be impossible as that would mean he would be doing every knee replacement in the state and then some. We just don't have the patient load up this way. My OS has been a surgeon for 25 or 30 years and he does maybe 3 a week and many weeks none but his life time of experience makes him very capable.

Good luck and I hope you find a surgeon that is willing to work with you and is considerate of the travel issues.

 

[Gringo]

Thanks Simon, I am going with the surgeon I originally chose. In fact, the left knee is schedulled for later this month. I am going to try to get both of them into this year, if I can. My other knee is not as bad. I did have part of the medial meniscus removed about 20 years ago, and that is the portion that is falling down on the job now. Where I live is a difficult place for handicapped people. There are really no 'accessibility' laws in effect and the terrain is pretty rugged. I should post a photo just of the 'driveway' between my house and my garage/workshop. You need four wheel drive to get from my garage to my front door, about a hundred feet away.

So maybe having one "good" knee in operation until the bad one is fixed does make sense. It would seem to cut down the risk of infection, and the consequences thereof, as well.

 

[Gringo]

I have another question. I just looked at some photos taken of me yesterday afternoon standing next to my old best friend from High School and College some 40 plus years ago. He flew down to visit us here last week.



We were basically the same height in our youth, he was maybe a quarter inch taller, at times, but we kept up with each other more or less right up into our 20's when we were full grown. Now, of course, with my bow legs and collapsed knees, he is an inch taller, or more.

My question is what happens to you when you get one knee done first? Is the doctor going to straighten out my worst knee ( my left one) and put a spacer in there instead of the meniscus, that will bring that leg longer than the unoperated knee?

If that is the case,what is it like to go from a leg being shorter than the other, to it being longer than the other?

I am presuming that eventually when I get the other knee done he will equal them out, but is this the scenario?