The Continuing Saga of bones, ligaments and knees

The Muddy Mess Starts.

Cruising into Tica Tica Bolivia, 1/15/06. 5 minutes before accident

I ventured to Newport Beach yesterday to visit legendary orthopedic specialist Warren Kramer. He focuses on knees and ligaments and has earned a reputation among motocross racers and pro surfers. In fact, seven time world champion surfer Kelly Slater has been a patient of Kramer. But I’m diverting.

I walk into his modest but busy office. My doc is actually Warren Kramer, III. His dad started the practice (the second) and another Kramer (his brother) also share the shingle on the door. Framed magazine covers and articles touting the Kramers’ proficiency grace the walls while a pleasant receptionist hands me a clipboard and a pen. Every doctor wants to know your medical history.

Later an x-ray technician leads me to an exam room and after telling him my predicament his jaw drops and eyes open wide in amazement. So fascinated he is about my story and my journey time passes quickly until a knock on the door reveals Dr. Kramer.

“Are you ready for us?” Slightly flustered the tech fumbles over the words and exists quickly to tend to his camera and another patient while Dr. Kramer asks me to tell my story to another young doctor in training and his attractive assistant. “it’s almost five months to the day,” I explain to them. “But these screws and rod in my leg are bothering me.

Kramer, dressed in a neatly pressed shirt with a tie and pleated dress trousers interrupts me. “Allan, are you or have you ever been married?” I explain that I’m divorced. “Then you know what it’s like to never be satisfied.” It takes a minute for the joke and his humor to sink in. As he looks at my x-rays he explains that I should be very happy with Chang’s work on my leg. “I’d be real happy if I did this surgery.” He starts spitting out the technical jargon of my fracture and the surgical repair as his young and attractive female assistant carefully balances a laptop on one hand while using a stylus pen in the other to enter the doctor’s details into the computer.

This continues for much of the examination as he asks me to lie on the exam table while he pulls, carefully twists, pushes and feels my knee and my ankle.

“Lachman’s. Negative.” He has me move. “Anterior drawer. Negative.” He asks me to loosen up, relax. “Posterior drawer. Negative.” He repeats one of the tests explaining that I was giving him a hard time. Again, the pretty assistant is instructed. “Negative.”

I sit up. He steps back and looks into my eyes.

“Allan.” I’m waiting for the bad news, the good news, any news. I’ve explained that I still limp, have little strength and the instability of my leg is disarming. “There’s nothing wrong with your knee. I’t s poster example of a perfect knee.” I think back to the day Dr. Chang performed some of the same tests and came a different conclusion. ” As for your ankle. Perfect.” I think to myself why then did Dr. Chang write a prescription and arrange for me to be fitted for a custom ACL brace. Though I remember Chang did say “I’m not an ACL guy” and referred me to Kramer.

“But you do have one problem, Allan.” His steely blue eyes nervously moving back and forth. Oh great. He found something else. My feet are dangling off the edge of the table. I’m kicking them back and forth, waiting for his diagnosis.

“One problem. Impatience.”

Great. If there is one thing I’ve practiced and feel have perfected over the last few years and especially on this motorcycle journey, is patience. I’m not in a hurry. And I manage my expectations, especially when dealing with different cultures.

“Some people are limping after a year with this type of fracture. But you’re fine. Get on your motorcycle and finish your trip.” When I ask him about removing the hardware he is cautionary. “You shouldn’t have it removed for 12-18 months. Go on your trip and if it’s still bothering you when you get back, then entertain the notion of surgery to remove it. But don’t do it now.”

I think about Chang again. He was willing to remove it and use a scope to examine the ACL. Remember? That was my thought process and strategy: remove the annoying hardware and while under there check out the ACL. If it was torn or ruptured consider fixing it during the same operation. That’s when Chang told me he wasn’t the guy to fix and ACL. He could pull out the hardware. But the ACL repair would be better suited to Kramer or another specialist. Also, confirming Chang’s diagnosis (or Kramer’s for that matter) would require either the surgery or an MRI. The metal in my leg will interfere with the MRI.

So I’ve got one doc who was so confident that my ACL is torn he arranged for a brace. Now I’ve got a specialist who’s examined \ “thousands” of knees telling me my knee is perfect. I’m confused.

Dr. Kramer is going to call Dr. Chang. I’ll call Chang next week to hear his side of the story. Meanwhile, Kramer tells me to work my leg overtime. “Stationary bike. Stairmaster. One legged squats. Do it till your thigh burns.” That’s how I’m going to get my quadriceps back. And according to Dr. Kramer, once my quads are solid my leg will no longer feel unstable.

I’ve been working on it. So I’ll continue my homework. Meanwhile the days tick by.