D-I-V-O-R-C-E

Well, the honeymoon is over. The divorce is final. I am no longer married to bi-weekly, 15-minute physical therapy sessions. No, I'm officially left to do (and count) leg lifts all on my own. If you read my blog from last Friday, then you know how I was so desperately trying to redevelop a positive opinion of the post-op physical therapy industry. With a history of experiences at PT facilities that only conjured up words such as "incompetent," "useless," "needless," "insurance scam," and, oh, did I say, "incompetent," "useless," "needless," "insurance scam?"

Granted, I have more resolve and determination than most, so I'm willing to endure more pain and work harder at recover than is expected of the typical "post-op" victi . . . err, I mean patient, not including the fact that simple knee surgeries require less specialized equipment to re-strengthen than more "sophisticated" injuries, I could probably make a full recover regardless of any intervention by "professionals." With that said, I respect my surgeons, and even though they are business partners in the PT facilities they recommend (I can't blame them for that!), I do my best to fulfill their prescription for my recover, even if it means paying money to do leg lifts on a table in a brand-spanking-new high-dollar facility.

That's where I was last Friday as I entered the PT place. I was immediately on guard, looking for ANY reason to find fault in the entire process (can you blame ME?) Although I didn't mention it in my previous blog, I was quickly unimpressed with the office staff. Not only were they not very friendly, they were too casual to pass for professional, offering vague instructions regarding the whole check-in-I-need-to-see-your-insurance-card process. They then proceeded to make fun of my checks, purple ones that I seldom used. The check was somewhat wrinkled and had a few coffee stains on it from riding in the console of my car. Had they and I had any emotional investment, I would have passed their rollicking as friendly persiflage, but as the entire staff got a laugh at my expense, and the woman processed my check like she was holding the ebola virus, complete with disgusted look on my face, I felt angered. In ensured everyone behind the counter, quite hyperbolically, that I was confident the banks would still acknowledge the paper voucher with my signature on it. "Did you change the oil with this check," she asked from behind the counter. I answered indignantly and facetiously among the crowded waiting room, "Well, you know, when it's all you've got . . . ."

Things were NOT going well. I only hoped the therapist could redeeem her office staff.

She absolutely did.

I had a wonderful therapy session, and I am STILL impressed with Katie. Read the other blog to see why. But that brings us to today.

As I checked out last Friday, I discussed the full schedule of my future visits with the "check hater." Tuesdays and Fridays would not work for me because of Friday Night Football (all caps.) We decided, together, verbally, out loud, vocally, with a witness, that I would come every Tuesday and Thursday for the next 4 weeks either at 4:45 or 5:00. As I was writing all this down, simply because that's how thorough I am, another office staff member said deigningly, "Oh, she'll print that all out for you!" I knew she didn't like my purple checks either. I assured her that a duplicate copy of a Tuesday/Thursday schedule wouldn't hurt anyone. I think my grin came off as sincere. I was handed a piece of paper that had the dates of my future appointments. I say many calender dates: 10/7/08 10/x/08 . . . . The computer program had a row an column for seemingly everything. Nowhere was there a column for "Day of the Week," however there was a column for "Length" of therepy session. 15 minutes filled every row. Before I left, I was reminded of the $25 dollar fee for any appointment that is not cancelled at least a day in advance. "No problem," I thought. "Tuesdays and Thursdays, like we agreed. Show up at 4:45." I've GOT it.

Since that first day, last Friday, I have actually been looking for this 2nd session on Tuesday, today. Although I had been making great progress on my own over the weekend, my quads seemed unnecessarily soar, and I was anxious to ask Katie, the expert, if I was pushing it too hard. Since I arrived at the facility 15 minutes early, as I am wont to do (character flaw), I decided to check the voice mails on my cell phone, something I am NOT wont to do. As I sat in th parking lot of the PT place, I listened to a voice mail from Monday, yesterday, at 5:16. It was from the PT people:

"You had an appointment today at 5:00. It's now 5:15, and you're not here. Can we expect you today? Can we expect you at your next appointment on Wednesday? Please let us know. I'd like remind you that there is a $25 charge for cancelled or missed appointments. Have a nice day."

I actually added that last sentence, but the rest of the message was true to form. I walked inside, dubious as to whether they would acknowledge their professional gaffe. As I entered the door, two women laid eyes upon me. One was the "purple check hater" who scheduled my appointments, the other was a new lady I hadn't seen before. They reacted like they recognized me, but acted like they didn't. With nobody in the waiting room, the place seemed "closed for the evening."

I quickly, directly, and without hesitation explained the quandary I found myself in. "You must be Kevin," the new lady replied. Great! I thought. They've been talking about me, or at least expecting me. As it turns out, this FIRST week, my sessions were SUPPOSED to be on Monday and Wednesday, not the Tuesday/Thursday rotation I had agreed upon with the now silently grinning woman sitting compliantly behind the counter. I looked the "purple check hater" straight in the eyes and said, "we agreed on Tuedays and Thurdays!" Anticipating the easy-money seeking quip regarding missed appointments, I said to both, "I don't think it's fair that I should have to pay the $25 fee for a missed appointment I didn't know I had."

Almost before I could conclude my sentence with the sincerest, calmest gravity I could muster in a time like that, the new lady interceded with "we will wave the fee this time as a courtesy, but we DID give you a printed schedule of your visits."

I could hardly contain my gratitude at her understanding and thoughtfulness. Hundred of things ran through my mind as a possible response: "You want to talk about courtesy!! How about the courtesy of saying one thing and doing another? How about NOT waiving a $25 dollar fee in my face at every chance you get? How about ME charging YOU with a fee for the gas and time I've wasted in coming to see you today? How about I make fun of YOUR checks, or better yet, we just acknowledge societies different form of payments, take our money, and shush?"

I said nothing more than, "Thank you."

As I contemplated where the conversation would go from there and whether I was going to continue going to that place, as the "purple check hater" handed me ANOTHER copy of my schedule that STILL disagreed with what she and I spoke about, the new lady's voice broke the silence: "You're next visit is October first at 5:00. Can you make that one?"

I felt the blood rush up, then I forced it down. With the additional copy of my paper schedule in hand, I said, "No. I cannot make that one, for I believe the first of October is tomorrow, call it a Wednesday. Either way, it is NOT a Tuesday or Thursday. In fact, I will NOT be able to make any more of the scheduled visits, regardless of when we think they might be. Please cancel them all. I really don't appreciate any of this."

I walked out, punching myself in the gut for not lashing out more, only causing myself more damage. I'm sure the two office ladies had a good laugh at my expense then brought up my stained purple checks again. I was livid . . .

. . . .but relieved. I didn't have to go back. No more $20 co-pays for 15 minutes of leg lifts that I do at home 10 times over for free.

As I drove home, I thought of how the two office ladies would explain the situation to Katie, realizing that they would portray me as an out-of-control, anti-establishment maniac who does'nt know his his days of the week from his preferable forms of payment. I felt bad for Katie, who should by every professional right, deserve the income generated from my rehab. I also felt relieved that I would be able to monitor myself, and to heal and progress at an accelerated rate that would have astounded the health care professionals anyway.

I can't wait to tell my doctor that he will only get a return on his business investment if he can get his people to successfully schedule a patient's return.

Welcome Back Korpi

Wow! What a day back at school. Shortly after I arrived at 6:50am in order to assess what the substitute had done during my absence, I was greeted by my first student seeking mathematical knowledge. Soon, one became two. Two became four. Four became eight. My classroom began filling exponentially, literally, not just in the casual sense that almost ALL non-initiates use to describe ALL things that grow rapidly.

My plan for catching up on paperwork quickly was put on hold. In one sense, I was a little worried that I might have to finish all my paperwork tonight at home, putting me further behind, but in the other sense, I was delighted that so many students felt compelled to welcome me back to school in person an hour and a half before school even began--rather oxymoronic. Anyway, the "party" was forming all around my teacher's desk, with students fanned out along the perimeter of the desk in a radius that extended nearly three students deep. "How is your knee doing Mr. Korpi I don't understand this!!!" came the polite but distressed cries. I listened carefully for a sign of where to put the punctuation mark in their comments, listening to the tone and inflection in their voices, but to no avail; their niceties were slurred along with their conscientious pleas for help.

I'll admit that it was ambitious of me to expect 110 students teach themselves all about discontinuities of functions and the entirely foreign concept of the "limit" via a printed, albeit energetically written, packet of notes. Throw in the use of the calculator in a novel way and the fact that the examples are designed to keep them on their toes, and you've got an explanation for the throngs of students assembling in my room this morning.

Not only am I thoroughly convinced, however, that if left to their own devices, these great students would eventually figure it out, but I'm equally impressed that so many of these students are NOT content with NOT knowing, or finding out later, but instead, take it upon themselves to seek out the help they need. Never before have I had such a "thirsty" core of students who are so motivated and diligent in the face of uncertainty, apprehention, and frustration. These are great qualities to have and exercise. If I was an outsider looking in at myself, I would think that I planned the lesson to be one not only in mathematical concepts, but in perseverence and assiduousness.

Those who came in this morning were rewarded with the serentity that comes both from at last understanding the concepts and from knowing that they weren't going to have to turn in the assignment afterall. Those who didn't come in either thoroughly understood the information (GREAT!!) or were perhaps simply content with not knowing, hoping to pick up the info here, there, and in between. Everyone, though, did get the entire lesson live in class later that day. As is usually the case, those who had invested more prior to the lesson got so much more out of it.

Kudos to all. Tomorrow, more limits and discontinuities. Until then, it's time for me to ice and elevate my knee. Man, Does it smart!

I lost count . . .

I just returned from my first physical therapy session of my new knee. Now, my previous experience with physical therapists has not been good. A little background will help you appreciate my point of view.

Four years ago, after my ACL reconstruction, I was assigned to post-op PT at a local place that amazingly accepted my insurance. After my initial consultation, where the licensed therapist measured the maximum angle at which I could bend my knee (in degrees, not radians . . .), I was told to return 4 times each week for treatment. No problem, I thought. THEY are the professionals. They have special training and fancy equipment that will help me get back to 100% sooner. Much to my dismay, my insurance was paying for something I didn't really need. The first several visists involved nothing more than me doing leg lifts, the same ones I was doing at home. The therapist wasn't even counting for me. I had to do it by myself, just as I was doing at home, except at home I was able to watch Sportscenter. At the office, I was watching a wall and a therapist who was scribbling into his notebook. When I showed up the morning of the day I went into surgery with the first infection (see yesterday's blog for the chronology), I expressed some serious pain when doing (and counting) my "heel slides." "Pain is normal when you're recovering," was the reply. I remember it was a rainy morning, and I was sitting on a bench in major agony sliding my heel along a bench all by myself while my therapist was getting coffee or something.

"Is my knee supposed to be this big? this red? this painful?" I kept asking, but the walls wouldn't answer. It was later that afternoon when I called my doctor and told him my symptoms. We immediately went back into surgery to get try to get rid of the infection.

It was with this experience that I went to my PT visit today, albeit at a different location. The two ladies at the front desk didn't give me much confidence with their casual demeanor. The overdressed, blond, perfectly manicured male joking with them behind the desk only strengthened my belief in the tremendous money-making scam these "professionals" were pulling off. My "script" as I later learned it to be called, was not prescribed by my doctor, but instead, the length and duration of my treatment was left up to the professional judgement of the same people who were joking about the color and style of my checks. My distrust and animosity was almost boiling over.

Having walked into the place without crutches, without pain, and having successfully completed the entire regiment the yesterday of exercises prescribed by my doctor (counting all by myself!), I envisioned the office prescribing 3-4 visits per week, in the middle of the day, for several months, with a $20 co-pay required each time, all for me to show up, lift my leg, and count to myself. I told myself that this would be my first and last visit if I wasn't pleased with what they had planned for me. I was not going to be fleeced! I could do my own rehab at home on my own floor, sliding my foot along my own wall. . . .with Sportscenter.

Soon afterwards, Katie, my PT, came and retrieved me from the waiting room. I shook her hand with reluctant skeptisism, but with sincerity. As I asked her what her plan was, she immediately put me at ease by telling me she was just going to assess me first. She was very impressed that I was walking without crutches and without a limp less than 48 hours after surgery. I was trying desparately to give her every indication that I did not need her services, and that I was only there on doctor's orders. Because a former calculus student of mine was on staff there, she knew I was a math teacher, which meant she knew that I KNEW HOW TO COUNT, especially for only 3 sets of 20 reps of leg lifts. I was SO waiting to let her have it! I wanted so badly to walk out of the place on a gimpy leg only to let them take advantage of someone else.

But I didn't . . . .

Katie had a very calming effect on me. She was the real deal. She actually counted with me as we did our preliminary exercises, which she only made me do to make sure I had proper form. She was impressed. I had done them so many times before. In fact, at one point, I admitted that I had lost count while talking with her through my "knee flexes." She joked that she wasn't the mathematician, but that I had exactly "three left." Very nice! At least she was counting. The most impressive thing about her was that she fearlessly "undressed" my wounds without squirming or using gloves. With this afternoon being the appointed time to change my very bloody dressings, I had to go to PT with the original surgical bandages on. I really wanted to change them prior to going in, but they were still "oozing" slightly. She not only took off the bandages, but she helped me clean up the area with alcohol swabs. I was won over.

In the end, she prescribed me 4 weeks of therapy, with 2 sessions each week. She even went as far to say that if I showed such promise that I wouldn't need her services, the therapy could be abbreviated at any time. She also promise that we would be doing activities that weren't so "boring" as leg lifts. I TOTALLY owe Katie everything for restoring my faith in the physical therapy profession. It's going to very hard to cut our sessions short, because I don't plan on doing 8 sessions at $20 co-pay a piece. I'm going to get it done at home and much, much sooner.

Perhaps I'll send her a gift certificate for the difference in what I save in co-pays to make up for her "lost income."

Thanks Katie! You actually seem like someone that would acknowledge a puss-filled sack around my knee as "irregular" and not just a requisite painful part of rehabbing on your own but paying others for.

Surprise, Surprise!

Today is my first full day of my sitting around the house staying off my feet in the name of surgical recovery. I have to admit that I'm not very good at it. Consequently, I've been more ambulatory than I might supposed to be, but the doctor told me I could put as much weight on it as I could tolerate. What he didn't know is how restless I am and my remarkable tolerance for pain.

To describe the surgery in a little more detail, it was supposed to be a repair or trimming of the right lateral meniscus on my right knee, a knee that has seen its fair share of slicing, dicing, and bacteria. The pre-surgical MRIs revealed a lotof black and white "stuff" inside my knee, things the untrained eye would have difficulty making sense of, but what my doctor told me looked liked "an irregularity in the vicinity where I had described the pain." I'm glad he knew at this point I wasn't making up the entire scheme simply to get my "surgery on my knee" card punched again (the 10th one's free, I believe!)

The MRI did reveal some dark cavities that were remnants of my ACL repair-attempt surgery 4 years ago, oh the nightmare. After a successful hamstring graft, the new ACL was coming along great when after several weeks, the severe pain and swelling that occurred overnight meant I had an infection. Immediately thrown back into surgery for and "irrigation" and "debrisment" which means "cut me open and wash everything really good," I was in the hospital for several days and was taking powerful antibiotics through a peripherally inserted central catheter (picc) line, as I would continue daily at home for the next 6 weeks. The infection left, my knee was getting stronger, then suddenly . . . .

. . . the severe pain and swelling that occurred overnight meant I had an infection . . . again. It had returned, and this time with a vengeance. Thrown into surgery again, this time the doctor removed everything from the first surgery, the hardware and the graft, or so I was told. With the bacteria hiding inside my knee on the titanium screw used to hold my new, healing ACL in place, the only option was to get rid of it all, lest we risk yet another infection or even death. With another central line, nearly a week in the hospital, and another 6 weeks of intense Vancomycin antibiotic through another picc line, the infection finally went away, and was left with some ugly scars, major bills, and an ACL-less right knee, again . . . . or so I had thought.

During yesterday's surgery, I gave the doctor permission to do whatever course of action he needed to take to get me back to where I could run again. He had a blank check to prod, poke, drill, scrape, glue, tattoo, or anything he needed to do. I wanted this to be my last surgery, and I wanted to run. I also paid that extra $10 for the sterile "bacterial-free" operating room. We also agreed not to insert another ACL, since the apparent scar tissue from the previous 3 surgeries was acting like a "virtual" ACL, holding my knee in place remarkably well. The torn meniscus was not as big a tear as we had thought, so the excess was simply trimmed away. He did, however, discover a couple of things inside he didn't expect to find.

Behind my patella, there was some damaged cartilage, simply from wear and tear, and indication that my knees were in fact not the most suitably designed patellas for a runner. That would explain a lot of developing pain in BOTH of my knees prior to the accident that damaged the meniscus. He was able to trim that up rather nicely, although it had some very dire consequences as far as I'm concerned which I will get to shortly.

The biggest surprise of all was that there was, in fact, a sliver of the original ACL graft, not the entire thing, but a thin band that was doing its best to hold my knee together. This puzzled everybody. I distinctly remember being told on my third surgery with the infection that "everything came out," and that is was heartbreaking to remove the graft because "it was looking so good." I don't see how I could have misinterpreted that statement, but apparently I did. We're guessing the bone had ossified enough around a portion of the graft that it was able to remain even with the supporting hardware removed! That would explain why I was able to run my marathon, much to the amazement and bewilderment of myself and everyone who thought I was an ACL-less runner.

I have to say that I am actually very, very relived to know that of those horrible three surgeries, with all the time, pain, heartache, drama, and money, that a sliver of the purpose of them all remains inside of me. I'm comforted to know that I DO, in fact, have slightly more than scar tissue holding my right knee together, although I am still left puzzled over how that could have been miscommunicated to me and my wife.

Anyway, today I'm in very little physical pain, even though I can still see, feel, and smell the seepage that is oozing from the surgical site. I'm getting comfortable wearing these "man hose" over my legs, although it's a look I don't think I'm going to keep.

So back to the fallout of yesterday's surgery and the implication of the unexpected patellar cartilage damage. I'm done with running. That is running every day. Running for life. Running for fitness. Running for pleasure. Running for peace of mind. Running for good. The doctor said with the continual pounding, my knees would continue to grind away at the cushioning cartilage behind them, causing more pain and more deterioration, which would mean more quick-fix surgeries until there was nothing left to trim. Not a good scenario.

I still haven't come to grips with this yet. Getting back into running was the whole reason I braved this surgery to begin with, and now it's been the one thing that will trigger the end of those days. Sure, I can bike. I can swim. I can walk. I can run on an elliptical. But none of those is running, and none can take me where running could: weaving around the sidewalks of downtown, around rivers, through trees, and parks. All I needed was a gym bag in the back of my car with a water bottle and my running shoes and I was free to set out from anywhere at any time.

For now, I'm glad the pain in my knee is gone, or will be gone, and I don't want to do anything that will make it return, I just don't know if I'm ready lifestyle change that comes with the artificialness of running on a treadmill or the silly, awkwardness I feel on a bike. Besides, I know how inhospitable drivers of automobiles can be to bicyclers. As for swimming, the cheapest health club with a pool is $60 a month, and my tub is too small to swim laps in. I guess the only thing that comes close to what I want to do is speed walking. Hey, it IS an Olympic event!

Any ideas?

Speedwalkers look almost as funny in still-frame as they do in real-time.