Dr. K., You're one of them.

  By that, I mean a doctor.  Not that there's anything wrong with that. Being a doctor is a very good thing.  But when you're advising a patient about medical  choices with a doctor, and especially a surgeon, you must be venturing into the area of professional courtesy, one physician to another.  
    Most patients would not have the temerity to interview a doctor about available options.  Or maybe it's just me.  Once I committed to having knee replacement surgery, and selected a surgeon, I pretty much opted out of any decision making.  It is true the surgeon I selected was not the first one I sought help from.  Several years earlier, at my first visit to an orthopedist, I was totally surprised when he told me that the worst thing he could tell me was that I needed both knees replaced. That was what he was telling me, he said, and he could do that, in relatively short order. He said I needed him more than he needed me and to call his office to set up an appointment when I wished to.  He never mentioned any options, and it never occurred to me to ask.
    So, about 7 years later, when my knees were so painful to stand on,  I could hardly cook Thanksgiving dinner, not to mention barely being able to walk  across the lawn to the end of our yard, and having my own child tell me that it appalled him to watch me hobbling around on my crooked and bowed-out legs, I seriously contemplated  the  surgery.  I called another surgeon, though, one who came highly recommended not only for his expertise in orthopedics, but also for his appearance. A woman poll inspector in Raymertown claimed he had enabled her to go from  wheelchair-bound to being able to not only walk without a limp, but to skip.  And to prove her point, she actually skipped around the room.  She went on to say that her orthopedist was not only the best doctor she had ever seen, but also the best-looking man she had ever seen.  Similar testimonials were given by our own librarian.  I was ready to discount their glowing reviews, but when I mentioned the surgeon's name to  my brother-in-law, his first comment was what a handsome man he was, in addition to his surgical skills.
    At my appointment with him, he took a detailed history, stated that there was nothing that contra-indicated TKR, and told me he could fix the knee and straighten the leg.  He suggested I go home and talk it over, but I said I'd schedule it right then.  But, Dr. Komaroff, at no point did the discussion of surgical options arise.  And it is true you write that your surgeon MAY discuss several choices.  The surgeon I saw was careful to explain everything that could possibly go wrong, including the eventual deterioration of the "artificial materials."  But he did not offer me a choice of materials, he did not ask if I wanted cemented or cementless implants.  He did not let me choose between a fixed-bearing or rotating knee platform.
    I think for most of us, who are not member of the medical profession, and who do not want to spend an eternity searching out every possible angle, the best we can do is pick a surgeon who we have heard good things about. I think it is true that most such surgeons have developed their skills using a certain protocol.  If they use cement to glue the parts in place, they are not going to go cementless. They are not going to waver between fixed and rotating knee platforms.  They will have made their choice of implant, from the lab they have chosen.  
   To summarize, in my case, and I suspect most, the surgeon informs you of what appliance he uses, such as "Signature."  He does not ask the patient what procedure or materials or technique they want.  I guess it may be different among the society of physicians, but, Dr. K., that's how it works out for mere mortals.
  
 

A.I. Moment to Remember

    It was May 25, 2005, the end of Season 4.  We'd picked up Dorothy and were traveling to Cape Cod, where all the boys already were.  The rain came down in buckets on the drive that night, forcing traffic  to a standstill.  American Idol was hot back then, and we were eager to find out who would win. Carrie Underwood edged out Bo Bice.   ("Scary Underwear or Mo' Ice? " read the sign on the cabin door.)
     The final season came to an end April 7, 2016, a day when the rain also came down in torrents.  The length of the show's  run had been curtailed by increasing apathy and ennui, the two finalists pale reflections of contestants who had gone before. We learned that Trent beat out LaPorsha, and that Bo Bice now sports a crewcut.  Alas.

Tick Tock

   February 1st was a nice day.  I walked along the roadside in front of my house and picked up some litter that slobs still throw out of their cars. Later that afternoon, as I was on the computer, I detected a tick crawling on my leg. It hadn't bitten me yet,as far as I could tell.
   Yesterday, April 1st, was also a nice day.  It had been windy, and I picked up some branches on our lawn that had fallen off the maple tree in front of the house, dead branches, some quite large.  I threw them down the bank behind the house.  Later, that night, my arm felt itchy and I scratched it, loosening what I at first thought was a small scab, a very small scab.  I was next to the bathroom sink counter, where I saw it move.  It was a tiny tick, evidently lodged just under my skin.  That area of my arm has, not  a bull's  eye rash, but a circle of small dots, as if the tick was trying to find the ideal blood-sucking spot.  I just hope it was a healthy tick.

Dr. Who?

   Received a call this morning about my annual doctor's appointment, a visit not scheduled until late June.  A man identified himself as Adam and said he was calling to tell me that Dr. C., whom I had been seeing there for about 20 years, would not be at my June appointment because he was leaving the practice.  He didn't give any reason for his departure, nor did I ask.  "Would you  like to schedule with another doctor there?" he asked. I said sure.  What do I care?  I'm pretty sure that Dr. C. is not retiring as yet, and it seems they would have commented about an illness.  I thought it was usual for a person's physician to notify his patients that he was leaving, but that may be  a courtesy from the past, and probably a doctor's departure has legal ramifications.  "Doctor, Lawyer,"   they're of the same ilk.
     Anyway, that particular office causes me such distress just by entering the door or, even before, the parking lot, that I wouldn't mind avoiding it altogether.

Patient Parsing or Words and Numbers

      In the vast and mysterious medical world of patient  encounters,(Yes, that's what they call them--you can look it up) I have come to the conclusion that numbers trump words, almost every time.
    Test the theory. Walk into a medical office, prepared to state your case. That means you want to explain your condition or your concerns, if you have any, or to relate any perceived changes, or just to understand what has, or is, occurring in the mortal coil you know as your body.  Nine times out of ten, your doctors, or your medical providers, are sitting in front of a printout of your latest medical tests or notes presented by an assistant of some order.  It would be the first time the doctors have seen them, or thought of the patient to whom they applied.  That would be you. When they  turn from the computer and ask how you are doing, it's up to you whether to respond with your health issues, or to just take the query as a greeting, and respond accordingly.  "Fine, thank you. And yourself?"
   It doesn't matter, either way.  Your words are not supreme. The doctors rely on the numbers. What you utter is soon forgotten.   You will be directed into the cattle chute of possibilities indicated by your numbers, not your words.  And therefore more technical  data, fit to be deciphered into statistics which too often defy any meaningful verbal transition.