Monday, March 1, 2010
Dartmouth Has The Answers
On Thursday Feb 18 Rick and I went with some trepidation to Dartmouth Hitchcock Medical Center in Lebanon,NH. The hospital is "down the road" from Dartmouth College one of the oldest colleges in the US,making it one of the "Ivy League" schools.Daniel Webster,the famous lawyer,went there and is something like a 10th cousin many times removed from Rick.( Ok, it's a tad distant,but he is still in the family tree!)
Dartmouth Hitchcock has an excellent reputation as one of the best hospitals in the country.This being said,we were still nervous,especially Rick,who kept wondering what we would do if they said that there was nothing they could do for his knees. We had been so hopeful before only to be told there was nothing that could be done for him. Would he have to be in a wheelchair? Would there come a point where he could no longer walk at all? We needed two answers: an actual diagnosis,and a plan to fix it.
The trip took 2 1/2 hours,which went by fast. We pulled into the parking lot,finally found a space,and walked up to the building. The photo above was taken from our car. The first thing we noticed was how big the building was,and how many cars were there. The lobby was quite big,with four massive archways. To the left was,among other things,xray,planning,and a small food court. Straight ahead was orthopedics,and to the right was Dartmouth College Medical School. Right in the middle was a friendly receptionist who pointed us down to the left and told us which room to go into for Rick's xrays. We brought some MRI's and Xrays from the VA with us,but they wanted do some of their own,which was understandable. They called Rick in about 45 minutes early. After the xrays,we went right to Orthopedics. We were hoping they would take us early again,but that was not to be. Rick was impatient. I kept telling him that we weren't scheduled until 1:30,and he said he was just nervous about what they were going to say,and that he wanted it over with. He forgot to bring a book with him ( I was rereading Outlander by Diana Gabaldon)so the time seemed slower to him. Finally,we got called in.
The first person we sat in with was a resident student,a very nice guy,who's name I unfortunately can't remember. He asked alot of questions,regarding the pain,when it started,what the symptoms were like,and what might have caused the problems. He then pulled up Rick's xrays,and showed us Rick has lost joint cartilage on the inside area of his knees,whereas the outside areas are fine.He also showed us how Rick's legs are now bowed. We felt we learned more from those xrays than all the visits combined in the last two years. Mr Resident then said he would go over the xrays with Dr. Bernini and they would come back.
After about 10 minutes,Dr.Bernini and Mr.Resident come back in. Dr.Bernini is a knee and shoulder specialist,and had written a paper regarding the benefits of simultaneous bilateral knee replacement. He was very friendly and engaging."So...you folks need a diagnosis that is long in coming,don't you?" "Yes, please!!!!" I said. He went over some of the information with Rick again,and said the one thing that no one has said,"I want you to know that you are not crazy....your pain is very real and I know it's real. I have seen worse arthritis,but some people can have bad arthritis and not feel any pain;some people can have very little and be in alot of pain. You appear to have moderately severe arthritis." This was amazing. We have been hearing,"For what we are seeing here,you are claiming to have too much pain." Finally! He then asked if Rick's knees gave out on him,did he fall,did his knees make this sound,did they catch,and you could hear enormous relief in Rick's voice,as he responded "yes"to each question. Usually he would have to tell Drs what was going on,and they still wouldn't figure it out. Dr Bernini knew what was going on,we could tell by the way he asked the questions. He had Rick walk,try to stand on his toes and his heels, He had him sit on the table,and he commented at how loose Rick's kneecaps were.He asked Rick if he could stand up from the table without using his hands to push himself up.He could not.
" I have a diagnosis for you," Dr Bernini said,"and this is not what I think it is,it's what I know it is. He has all the symptoms." He turned to Rick and said,"You have Post Traumatic Degenerative Arthritis." The symptoms are the same as Osteoarthritis,in that it wears away the joint cartilage,creating bone on bone,which causes the grinding and popping that Rick hears. What makes it Post Traumatic is that it's caused by trauma to the body part. (Being a paratrooper,two knee surgeries,and doing 85 lb ruck sack runs in Iraq not to mention carrying that crap all day in the sand led to his problems.)There is no cure,it will only get worse over time. He said we have a couple of options:#1 Rick could get his knees drained and steroid shots in his knees two or three times a year.He would have some relief,but it would be very temporary and the fluid would just come right back, or #2 he could have joint replacement surgery. He is not a candidate for doing both knees at the same time because of his stroke history and his heart disease,but Dr Bernini said that he would do the right one first,since it's the worst,then after 6 weeks he could do the left knee.
I asked him about the bone infarctions,since there had a been a theory that this was what was causing all the problems. "It's a symptom,not the problem,"he informed me. "The infarctions were caused by the pressure from the inflammation and the loss of ligament." So the whole thing is caused by the arthritis.
Come to find out,Dr Bernini is also outsourced to the White River Jct,VT VA Hospital.He said he would send his report and health plan to the VA,and that he would talk to Rick's main physician.He said he would gladly perform the surgery,but the VA might want to do it through their hospital. Rick and I wondered if we could request Dr Bernini at the White River Jct VA.
So....we finally have a diagnosis and a doctor officially saying that he needs surgery.He also asked Rick why he couldn't exercise,and Rick informed him he couldn't move his knees in the proper rotation! He also asked about Rick's activities before his pain.All this is part of the making the case for surgery.
Now we wait for the VA...yet again. Since they are Rick's primary source of medical services,we have to go through them first. I told Rick if we have to pay $20 a month until we are 80 it doesn't matter,he is going to get his knees fixed,come hell or high water.