Knee plan coming into focus

In the last 36 hours I've driven the 1200-mile round trip to visit my friends at Proliance Orthopaedics & Sports Medicine in Issaquah, and I now have a pretty good sense of what to expect over the next couple of months. And most importantly, I feel like I now have the A Team engaged on the orthopedics aspects of my care, just as I already had the A Team in the infections side with Dr. Pullman and his team here in Butte.

I'm a big fan of Proliance, as I've mentioned before, and that's why it's worth it to me to drive 600 miles to see them. One of the things I've learned about orthopedic surgery is that the success rate for surgical procedures is strongly correlated to how many of those procedures the provider does. In other words, if you're getting a knee replacement (say), you want it to be a team who does knee replacements every day, and not a surgeon who occasionally does one.

On that note, there were 8 patients (including me) in the waiting room at 7:15 this morning. And Issaquah is just one of several Proliance facilities in the Seattle area.

Another thing that made me feel good about today's visit was my long history with this particular facility across the street from Swedish Hospital in Issaquah. This is the place where I first met Dr. Bruckner in the summer of 2015, and made the decision to have him replace both of my hips that fall (which have been 100% trouble-free ever since). The woman who checked me in this morning also checked me in for that appointment, and several appointments since then.

Brittany, the PA-C (Physician's Assistant Certified) I met with today, is also somebody I know from previous visits. She was working with Dr. Bruckner when he replaced my knee last year, and now that he's retired she's working with Dr. Hulst, the surgeon I will be meeting with next month who has expertise in infection cases like mine. It's great to be seeing familiar faces, people I already know and respect.

I brought along a 3-page printed dossier I had prepared for this appointment, including a detailed graphical timeline covering 14 key events starting with my knee replacement surgery last May. I wondered if they would think this was weird, but when Brittany saw it she said "I love this!" and then carefully studied the whole thing, while asking me questions and taking notes. Have I mentioned how much I love Proliance's approach to this stuff?

Here's a high-level summary of what I learned today:

• The knee is structurally sound. In addition to the X-rays, she pushed and prodded on it in various directions, and said everything seems rock solid. That stress testing hurt a bit, because of the trauma of the recent swelling and infection, but the important finding is that I can resume exercising. I had been working out regularly all summer, and haven't worked out for a month, so I'm looking forward to getting back to that. And the pain will probably go down as I build back some strength and flexibility.
• The tentative plan (to be confirmed when I meet with Dr. Hulst next month) is to continue the dalbavancin/rifampin antibiotics regime that I'm on through December, and during that time work to build strength, which will be helpful for whatever comes next. And there are two possibilities for what comes next: either the bacteria is 100% gone, and I just go back to enjoying life, or if the infection comes back, we then go immediately to a two-stage revision in which Dr. Hulst will replace all of the artificial components in my knee. I don't want that, of course, but if it's needed, we'll do it, and I'm confident that I have a great team to handle it and I can recover strong if that's what we need to do.

Overall, today was a great day for my peace of mind. My blood pressure at this appointment was the highest reading I've had in a long time (that was before the appointment), but I'm sure it's much lower right now. Looking forward to a great night's sleep!