"What started out as a pleasant afternoon of drugs and surgery has not gone as planned." -Zoidberg

Sorry for my absence.  It turns out it is hard to find time to blog when you have 3 children and are going to language classes.

As evidence of how hard it is to write with kids, after I wrote that single sentence my toddler climbed into my lap with a stack of books to read her-which I did.  As I write this she is tugging on my shirt with a NEW stack of books.

I have a lot of ideas stored up but for this entry I'm going to start to talk about my recent knee surgery.  I will have to split it into more than one post however. The difference in Health Care and Coverage between the US and Germany is stark.

So back in July I was playing soccer (Fußball) with my kids and I jumped onto my foot wrong and seriously injured my knee.  Honestly, we probably should have called an ambulance, but we still have the American mindset with that.  Basically here they are more commonly used (because you don't get charged 1000's of dollars for a few miles ride) and because many people have no cars and it is hard to get to the hospital by bike with an injury.  Instead though my husband brought me my bike and I scootered it home on my good leg.  The next day when I woke in the same severe pain we realised we would have to take the bus to the hospital.

After exams by multiple doctors (it is a teaching hospital so first I think it was a doctor in training, then his superior, then a knee specialist from the Orthopaedic department) it was determined that I most likely had a torn AC, but I would need an MRI to confirm.  Interestingly, although they gave me an X-ray in house that day,  the ER could not give me a referral to get the MRI as an outpatient, but rather had to give me instructions to give to my Hausartz (Primary Care Physician or PCP) who would give me the referral.  The X-Ray did show a "bone bruise" presumably where the ACL tore from the bone which may have been what caused a lot of the pain.  After I had an appointment for an MRI I was to call the "Knie Sprechstunde"-basically every Wednesday the Ortho department at the hospital focuses on knee injuries-to make a follow-up appointment.  They wrapped my knee with a steroid bandage to reduce swelling, gave me crutches and a prescription for 600mg Ibuprofen (and stomach acid reducer to protect my stomach while taking Ibuprofen) and sent me home.

Already I saw noticeable differences.  For one, I have had a similar knee injury in the US and my initial emergency appointment did not include a visit from an Orthopaedic doctor.  I had to make a follow up appointment with one myself-so that was time saving.  In fairness this may not be standard practice in Germany, it could be related to the hospital in my town being a large teaching hospital.  I found it interesting that I had to go through my PCP to get the MRI referral-I have noticed more items are routed through the PCP here than in the US, I am not sure if this is some effort to control costs, or a patient safety initiative.  The steroid bandage was new to me as well; I have had many sprain type injuries in the US and I have never had a steroid wrap used.  It was very effective at reducing the swelling and managing some of the pain.   I am not sure why the are uncommon (perhaps even unused) in the US.  One of the most striking differences-given the current US opiod crisis-was the fact that I was sent home with only high dose Ibuprofen.  In the US for similar injuries, I have been given opioid pain medicines, including Vicodin.  Honestly, the pain level was quite high especially because it was exacerbated by walking, which is a fairly common activity in my life.  Having only Ibuprofen for pain relief meant I had to do a lot of resting...probably more than I would have done had I been given stronger pain relief.

My Hausartzin (*in-I see a female doctor) was worried that the MRI places might have a long wait list (a month or more!) so she gave me 3 separate ones to call.  I called the one closest to my house first and they could get me in three days later!  This is funny to me because we've had this happen before where we were told it would be hard to get an appointment without a long wait, but it almost never turns out to be the case.  We regularly get seen very quickly and almost always same day for acute illness.

Unfortunately because I couldn't ride my bike and the nearest place was still about 3/4 of a mile a way we realised we would have to take a car.  My husband tried to use an hourly rental car service but had trouble and ultimately ordered me a taxi.  I had a little trouble finding where to go because it was a hospital campus (Asclepius) and apparently the MRI department was located outside the main hospital building.  So I was  bumbling around soaking wet on crutches trying to find the right building.  I did ask for directions, but I misunderstood one word (she told me behind the yellow building and my brain heard under the yellow building, so I was hobbling down a random staircase mistakenly).  I was trying to call my husband to see if he could call the MRI place and let them know I was late (and maybe get some better directions) but I couldn't get in touch with him.  I finally returned to the main building again and got the directions right this time but was unfortunately about 10 minutes late to my appointment.

Luckily, they didn't seem to upset (I am always worried about being late here since culturally Germans place more emphasise on timeliness) and I was able to fill out the intake form (with help from dict.leo as usual, since intake forms always contain lots of new and uncommon words). I was then given the MRI and and I had to wait to speak with the doctor there who would read it.  I had to wait less than a half hour to speak with the doctor after the MRI was complete-which I found surprising.  He started to speak in German and I asked if he could speak English, but he said no...so I had to listen hard.  He explained that my ACL was about 70% torn, I excitedly thought that this meant it might be possible to just do physical therapy.  This is because I was told when I was 16 and injured my knee skiing that I had a "small tear" in my ACL and would not need surgery, just 6 months of physical therapy.  Now I'm not sure what that was because they just did a physical exam and X-ray, I never had an MRI to diagnose, and I did feel a lot better after a lot of PT, though in fairness two years later I re-injured it skiing and had to do PT again.  When I expressed hope that it wasn't fully torn he said, no, it's torn a lot, and I kept repeating "but not fully" (in German) until finally he said "es ist kaputt!" meaning, it's broken.  I think he was of the mind that I didn't understand the words he was saying, but I did, I was just wrongly optimistic.

After this appointment I had to follow-up with the Knie Sprechstunde again.  I have to say, I really like the doctors there, and my care in most ways was superb, but I hate appointments at the Sprechstunde.  Normally, I don't have to deal with long wait times here.  It is the same or less than the US in general, but the Knie Sprechstunde is awful, I haven't waited less than 2 hours yet.  I wish they would just tell me my appointment is an hour+ later than it actually is since they know they will be running 2 hours late.  Well, they looked at my MRI and we spoke and determined that surgery is really the best bet.  The doctor explained it is possible to treat ACL tears conservatively, but that means never skiing, playing soccer,  basketball, or any sport that has sudden foot movements again.  Untreated tears also increase the risk of early arthritis in the knee.  Basically he said, the only time they don't do surgery is when the patient is quite old and willing to make serious lifestyle changes- this didn't really work for me.  They got out the calendar right then and said it would be 4-6 weeks....uh-oh, that wouldn't work.  I was flying to the US in late August, and then my father was visiting in October for two weeks, so they suggested I come back in October for a surgery sometime in November.

In the meantime I had a good friend that happened to also be a physical Therapist who I started doing PT with.  She was a great PT, really gentle and friendly and I think we did a great job building back up my knee strength.  It's always good to go into a surgery strong when possible as it will shorten your recovery time.  I was on crutches for 6 weeks after the initial injury, I don't think that is common in the US but they wanted to make sure that my bone bruise healed well because they explained that it is basically a lot of micro fractures in the bone and they heal much better without weight bearing. I did a good 3+ months of Physical Therapy with her and got to a good place pain wise.  I could ride my bike again and walk with minimal pain.  I still experienced occasional instability (feeling like the knee might give out) and some pain, but that was pretty much expected and helped me to understand why the surgery was necessary.  I made my trip to the US and my dad visited a few months later and just generally got on with my life (se my Reverse Culture Shock post about my trip to the US).

When I came for an appointment in October (and as usual waited 2+hours) the timeline had changed, apparently I couldn't get in for 8 weeks which would put my surgery a few weeks before Christmas...as I had to be on crutches for 4-6 weeks post surgery we decided Christmas on Crutches was not so much fun and scheduled the surgery for January 9th.

Tune in to my next post for my surgery experience.