Gary West traveled east to find the right surgeon to replace his knees. The Berthoud, Colorado, resident tells the story in his own words:
The question I was asked most frequently when I arrived in Columbia was a incredulous “What brought you all the way from Colorado for your surgery?” My answer was “Dr. Internet, I searched for the right surgeon on the internet and found Dr. Bal.”
It was a search that started in September 2006, when at the urging of my son, I decided to have my knees replaced. I could hardly walk a quarter mile without stopping to rest, the pain in both knees was so great. At night, the knee joints would slide around and lock-up, requiring me to move them by hand to roll over in bed. The pain was constant, day and night, and over-the-counter analgesics did not seem to do much good. His best argument was, “Dad, you are 62, why wait, get it done while you still have several years, sothat you can enjoy the results?”
Once I was committed, I started to search the internet for anything that I could read about knee replacements. Both of my in-laws had both knees replaced over a span of 16 years, so I had a frame of reference. Their replacements were performed with the traditional “long incision” procedure and recovered well, but not without a lot of hard work in rehabilitation lasting several months. I soon concentrated on minimally invasive surgery in my internet search and watched five or six surgeries on streaming video. During my search, I ran across an article in the on-line “Bonesmart” publication that intrigued me. This was my first introduction to Dr. Bal and his innovative technics.
I was intrigued by the descriptions of Dr. Bal’s procedures, so I called Dr. Bal’s office, and talked to Linda Landry. At her suggestion, I e-mailed a series of questions to Dr. Bal that evening. Imagine my surprise when Dr. Bal responded to my questions the next morning. I was really looking for a Colorado Doctor who had been trained by Dr. Bal. No such luck, but Dr. Bal invited me to consider coming to Columbia for the surgery. He assured me that his team was used to handling the logistics of out-of-state patients, and that it would not be a problem. We corresponded several times over the next few weeks. I was always struck by the personable manner in which Dr. Bal took an interest in me and my questions. Here I was, 700-plus miles away and would probably never meet him, let alone have surgery performed by him. Yet, he always wrote back within 24 hours with good advice and a kind word.
Still Columbia is a long way from Colorado, so I continued to look locally. I had a consultation with a local doctor in December. He agreed that it was time to replace both knees and was willing to do both at once.This was important to me as I am a consultant without sick leave; I could not afford to be off work twice for extended periods of time. I wanted to get it over all at once. However, I was not comfortable with the doctor’s responses to questions asked during the consultation, so I decided to go to Dr. Bal in Columbia.
When Dr. Bal said his staff could “handle” everything for an out-of-state patient, it was an understatement. Because of the travel distance, it was decided that most of the pre-operative details would be handled by e-mail. Linda took charge of getting the insurance approvals. I had a chest x-ray and EKG performed locally and e-mailed to Columbia. I also sent the x-rays of my knees taken during the local doctor’s consultation, to be used in planning the operation. Arrangements were made for a local Columbia physician, Dr. Delwood, to do the pre-operation physical and oversee the post-operative recovery.
My wife and I flew into Kansas City on the Saturday evening before the scheduled surgery. We were met by our son, who is a high school teacher in Smithville, Missouri. The three of us then drove to Columbia Sunday afternoon and checked into the Hawthorn Suites, less than a block from the Columbia Regional Hospital.
Eight o’clock Monday brought the pre-operation check-in at the hospital and the first questions of why we had traveled from Colorado to Missouri for the operation. Check-in went very smoothly. There were no problems at all with the insurance coverage. The hospital staff was very congenial and helpful, if somewhat befuddled by our decision to travel out of-state for the surgery.
It was then on to Dr. Delwood’s office for the pre-operation physical. Located in the building adjoining the hospital, Dr. Delwood’s office was very convenient. The examination was brief but very thorough. Although I am a Type 2 diabetic, Dr. Delwood did not feel it would be a problem to control the glucose levels during the hospital stay.
Given a clean bill of health by Dr. Delwood, next up was Dr. Bal’s office a short distance south of the hospital. There, my wife, son, and I met Dr. Bal for the first time. From the first handshake, it was like we had known Dr. Bal for years and had complete confidence in his skills and expertise. He introduced us to his operating room team, including Linda and Dr. Lehman. We were also introduced to Dr. Kussman, the anesthesiologist, who explained the anesthesia regime and the pain medications that would be used. I really had very few questions for Dr. Bal, he’d answered most of them in the preceding months via e-mail. However, in a moment of levity, he did promise that both feet would point the same direction when he finished.
Tuesday morning dawned as a bright spring day. Check-in at the hospital went smoothly. It seemed as though the pre-operation preparation only took a few minutes before I was wheeled into the operating room. One and one half hours later I was wheeled into the recovery room with two new knees! My first thoughts when I returned to consciousness was that the knees did not feel much different then when I had arthroscopic surgery to both knees in the early 1990s. The second thought was that Dr. Bal fulfilled his promise, both feet pointed the same direction.
By the first evening, I was able to sit on the edge of the bed and then stand for a few minutes. With the pain medication regime I was on, there never was any real pain to deal with, not at all what I had heard about from veterans of knee surgery. It did get old lying on my back, but the pillows under the knees seemed to help, as well as the ice bags. I did experience quite a bit of bruising which we later discovered was the result of a reaction to the Coumadin that I was taking to prevent blood clotting. In fact the Coumadin reaction was the only setback I had from the operation, one that extended my stay in the hospital several days, required two blood transfusions and allowed only three physical therapy sessions. Basically, the Coumadin thinned my blood too much, and it required Vitamin K therapy and the transfusions to resolve the problem.
I had three in-hospital physical therapy sessions, learning the proper stretching exercises, practicing with the walker, and learning how to go up and down stairs. The physical therapist said after the third session that I was cleared to go home as soon as they would release me for the blood thinning problem. She was pleased that I had accomplished the knee straightening and flexing that was required with only three sessions.
Seven days after the operation, the blood thinning was under control, and I was able to check out of the hospital for the trip home. Getting into a car was not as difficult as I had imagined. We broke up the trip by stopping once and walking with the walker for five to 10 minutes. I again walked several times at the Kansas City airport while waiting for the flight to Denver.
The flight home went smoothly. I was fortunate that the flight was not full and I was able to get a full row of seats so I could stretch out my legs. Bless the two men who offered to move to open up their seats for me. However, by the time we reached Denver and home about 9 that evening, I was running on fumes. It was so good to be home again.
Linda Landry had made arrangements for a home health care nurse and physical therapist to come to the house two to three times a week. The home health care and physical therapy were excellent. The therapist marveled at the small size of the incisions and the strength and flexibility of the knees. She said that I was at least three weeks ahead of any patient that she had ever had in her 20-plus years as a physical therapist.
I did suffer a minor setback during the second week after surgery with another Coumadin reaction. It resulted in a trip to the emergency room and more Vitamin K. That ended the physical therapy for the rest of the week. At the suggestion of my local physician, I called Dr. Bal’s office to see if I could be taken off of the Coumadin. After talking to Linda Landry and explaining the situation, I was told to throw away the Coumadin and switch to aspirin.
After only five physical therapy sessions, the therapist said that there was nothing more that she could do for me. Two and a half weeks after surgery, I was walking without the walker or a cane, flexion was at 120° and extension at 0° for both knees, and I could walk up and down stairs. She said that I should go back to the athletic club and slowly work on increasing my strength and flexibility. By this time, I was also able to stop taking the prescription pain medication and switch to ibuprofen after exercise.
Two and a half weeks after surgery, I started driving a standard transmission car and returned to work part time. Continuing to regain strength, I had to remind myself that I had had major surgery and that recovery would not occur overnight. I returned to my exercise routine of six days a week at the athletic club, gradually increasing the weights and walking or riding the bike longer. At about four weeks after surgery, I set a goal of participating in my first 5K walk/run, as a measurement of my progress. Ten weeks and five days after surgery my two grandsons and I completed the Berthoud Habitat for Humanity 5K race. I certainly was not the fastest runner/walker, but I was the fastest with two new knees! My goal was to complete in less than one hour, which I accomplished with a time of 55 minutes.
During my recovery, my friend from church, Jim Lawler, stopped by several times to see how the recovery was coming. He was scheduled to have a knee replaced locally in May. He was so impressed by my rate of recovery that he canceled his surgery and rescheduled to have Dr. Bal do his knee as well. Jim is a bicycler, averaging over 1,500 miles a year, and he was hoping to be recovered well enough so he could ride again this summer.
Jim had a single knee replaced by Dr. Bal the first week of May. His experience was similar to mine. He was very impressed by the professionalism of the whole staff in the office and the hospital. The surgery and rehabilitation went well and after a month and a half, Jim completed his first 30 mile ride in the foothills of the Rockies. He is now up to 130 miles a week and going strong.
As I look back from a distance of six months after surgery, I can honestly say that I have no regrets about traveling to Columbia to have my knees replaced by the capable hands of Dr. Bal. The staff is excellent and the accommodations for my wife were second to none. The whole process from start to finish was remarkable for its ease and lack of drama. Recovery continues, perhaps at a slower pace, but I continually see progress. Strength and flexibility are returning. I can enjoy hiking in the mountains once again. Last week, I was able to climb a ladder to the roof and clean the gutters. Life is pretty much back to normal.