Pre-Surgical Clearance

It takes me less than half an hour to limp crosstown from my home on the Upper West Side to Lenox Hill Hospital which means I arrive 10 minutes early for my 9 a. m. autologous blood donation. Given the fact that staff in various departments already have entered my personal and insurance information into a computer, you might expect the system to produce it upon command.  This doesn't seem to be the case when I register.  For the first time, I'm also asked if I have a health proxy.  I don't.

The nurse who takes my blood donation tells me she has put off getting a hip replacement.  She decided to do the injections first.  They haven't helped her much, she says, which I find more reassuring than her telling me that Dr. Ranawat is a great physician.  I tell her I have been advised never to donate blood because I am in a high risk group and I have had Hepatitis A and a positive test for Hep B antibodies, although I have tested negative for HIV.  She duly records this information.

I've never given blood before but am pleasantly surprised by the comfort of the reclining chair she tells me to sit in.  For the next 20 or so minutes, she tells me about the superior care available in New York City hospitals, based on the near-death experience her husband had with a mouth infection in New Jersey.  After my veins dutifully pump out a pint of blood, I can't believe how greedily I consume the Lorna Doones, Fig Newtons and cranberry juice that she gives me.

Next I need to be medically cleared for surgery by Carl Reimers, MD a Lenox Hill Hospital cardiologist in the adjacent building.  While setting up the electrocardiogram, his assistant apologizes but she will have to send me back to the same building where I gave blood for a chest x-ray and a urine sample.  Dr. Reimers appears briefly, asks me a couple of questions, reads my EKG and pronounces me fit as a fiddle.

So far, so good--all this has been accomplished in the allotted 2 hours.  But as I register for the 3rd time that morning with the chest clinic, I become a little weary of repeating the same information over and over.  I also have to wait nearly an hour before giving a urine sample and then it's another 30 minutes before a technician escorts me into the x-ray room.

Costly Referral

Dr. Markenson seems to have lost interest in me as a patient when my blood work comes back and is normal.  He also seems to have forgotten the specifics of my case, but he has obtained a copies of my X-rays and quickly reaches the same diagnosis as Dr. Kassipidis.  He also seems more receptive to injections, which he dismissed during my first visit, observing that I'm relatively young to be having a hip replacement.

The fee this time is $200.  But he also refers me to Amar Ranawat, MD who is affiliated with the Hospital for Special Surgery.  "I don't know anything about Dr. Kassipidis but if you've got a heart problem, you'd want to go to the Cleveland Clinic wouldn't you?" Fortunately, Dr. Ranawat sees GHI patients one day a week at Lenox Hill Hospital.  I waste no time making an appointment.

Holding Pattern in Primary Care

My longtime primary care provider, Paul Goldstein, MD seems miffed that I haven't consulted him at all about my orthopedic problems in between my semi-annual physicals.  Guilty as charged, I fill him in but wonder why it should matter since he would have referred me to a specialist in any case.  Besides, when I called his office last year for a referral to a urologist, the receptionist referred me instead to a neurologist, something I didn't discover until after waiting 3 months for an appointment.  Dr. Goldstein fell all over himself apologizing when I brought this to his attention but the lesson stuck.  Still, I'm surprised that a record of my visit with Dr. Kassipidis has found its way into my medical record.  This seems remarkably efficient, especially because Dr. Goldstein is also "out of network."

Dr. Goldstein extracts a promise that I will consult him after about next steps after I get the results of my bloodwork when Dr. Markenson returns from a 2-week vacation in Italy.  He's also big on prescribing medicine and he suggests tramadol, an opiod antagonist to relieve severe pain over an extended period of time.  I resist, as I do taking almost any medication, but accept the prescription thinking that maybe I can stockpile it to end my life if that ever becomes necessary.

Consult with a Rheumatologist

Joseph Markenson, MD at the Hospital for Special Surgery is supposed to be one of the finest rheumatologists in New York City according to a colleague in the New York City Health Department, where I have worked for the past 4 years as the World Trade Center Health Coordinator.  I've scheduled this appointment even though he doesn't accept GHI because the meloxicam hasn't helped much and I've begun to limp during my regular lunchtime walks across the Brooklyn Bridge and back.  I've also been told that orthopedic surgeons always recommend surgery so I'm seeking a second opinion.

Dr. Markenson does a very thorough examination and requests extensive bloodwork.  He notices the ridges on my fingernails and asks me if I suffer from psoriasis.  Apparently, there is a connection between arthritis and psoriasis.  He also suspects my hip is the greater problem because when he asks me to raise my right leg against the force of his hand, the resistance is much weaker than it was with my left leg.

I ask for more meloxicam because I've run out and I will be vacationing in the Pines for the next week.  Our house is located far from the harbor where the ferry docks, and I've begun to experience pain during the commute even while wearing sneakers.  I'll double my dose before going to the Ascension Party on Sunday.

Dr. Markenson's consultation fee is $600, most of which I will pay from my own pocket.  My housemates are divided, with one insisting I'm nuts to "go out of network" and another agreeing that if I can afford high quality health care, I should seek it.  Something tells me to go the more expensive route.  This totally goes against my frugal nature and a long held belief that one physician is a good as another, based on the experience of my sickly mother, who constantly sought medical care for a variety of ailments to no avail before succumbing to non-Hodgkin's lymphoma at 59 more 35 years ago.

Officially Old

I ride my bicycle to my first and only appointment at Riverside Orthopedics.  Welcome to assembly-line medicine.  Elias Kassapidis, MD seems competent enough, instantly diagnosing me with osteoarthritis in the right knee and hip as soon as he takes a look at my x-rays.  He observes that my right hip joint is more oval-shaped than the left one, a congenital defect.  As a result, my cartilage cushion is nearly worn away, thus producing the pain that sent me here.  Although he can't pinpoint if my worn knee or hip is more responsible, he outlines a course of treatment for both that includes painkillers, injections and eventual surgery.  He suggests that the prognosis is good because I'm active and obviously fit for my age, but he admits that I probably never will run again, something I had to give up years ago because of knee pain.

After prescribing meloxicam, an anti-inflammatory drug, Dr. Kassapidis observes that the shoes I'm wearing, sneakers, are likely to produce less pain that those with harder soles.  When I express concern about living alone and having to climb up 2 flights of stairs post-surgery if I decide to go that route, he blithely responds that in such cases, patients are typically sent to a rehab facility like NYU's Rusk Center.  He also mentions that 10,000 New Yorkers have joint replacements annually.

At 57, I am officially old in a way that I wasn't when I received my first invitation to join AARP.  The good news:  GHI covers the cost of the entire visit, including X-rays, aside from a $20 co-pay.