Second Opinion

"I've got to tell you, I feel like I'm cheating on Dr. Ranawat," I confessed.  Dr. Wang barely grinned.  Who knows what the internal politics at the Hospital for Special Surgery are like?

New X-rays hadn't been necessary.  My visit had begun with a young man who re-entered the answers to questions I already had answered online, and Nadzeya Zhylinskaya, a very blond physician's assistant, asked most of them again.  Say something once, why say it again?, a line from a Talking Heads song, definitely doesn't apply in American health care.  Nearly every person you encounter asks you for your date of birth to make sure you're the patient they think you are.  Sure, it's a way to make an identification, but Joe thinks the protocol has become a bit dehumanizing.

After explaining my reason for seeking a second opinion, I put Ms. Zhylinskaya, who once worked at the  Hospital for Special Surgery in New York, on the spot.  "What would you do if you were in my position?" She thought for a minute.

"It's probably easier to get the necessary tests and the pre-surgical clearances done in New York because HSS can take care of it all.  Here you're on your own.  But do you really want to spend a couple of months recovering from your surgery in New York if it's a cool and rainy spring instead of down here where you can go outside for a walk whenever you feel up to it?" 

Ms. Zhylinskaya made a good point.   At the same time, she reminded me of a drug rep for Purdue Pharma.  Her refrain to "stay ahead of the pain" in recovery seemed excessive.

Initially, my consultation with Dr. Wang didn't differ materially from the one I had with Dr. Ranawat but by the time he left the examination room I decided to have the surgery in Florida, although I still had a question.  As if he'd been reading my mind, he re-entered while I was tying my shoes.

"You know, given the fact that the only pain you're experiencing has been confined to the knee cap, you're a really good candidate for a partial knee replacement."

"Yeah, Dr. Ranawat mentioned that but I didn't want to hear any more about it."

"You might want to consider it.  Recent studies indicate that outcomes are just as good. Some of my patients who opt for a full replacement are less satisfied than those who don't because the surgery is a lot more invasive and they experience discomfort in areas where they didn't feel it previously.

I nodded while recalling Dr. Ranawat's ambivalence about partial knee replacements in our earlier, albeit brief discussion.

"It would significantly reduce your recovery time," Dr. Wang added mildly.  Say no more, I thought.  Once again, my desire to return to New York outweighed almost everything.

Dr. Wang briefly described patellofemoral arthroplasty.  It sounded like he would be putting rubber bumpers on my knee cap. A tongue twister came instantly to mind:   rubber baby buggy bumpers, probably not your typical reaction.

"Why don't we do a MRI to confirm your arthritis is limited to your knee cap and then decide what course to take?" he suggested.

"Sounds good," I replied.  Either way, we scheduled the surgery for April 11, his earliest availability.