Thursday, October 14, 2010

The Decision

When I began the search for the surgeon who would do my ankle replacement, I started with my health insurance company. I needed to make sure the procedure would be covered. Luckily it was, under ICD 9 code 81.56. Once I understood how the coverage worked and what exactly was covered, I needed to find a surgeon who participated with my health plan.

Initially I wanted the surgery done at the Hospital for Special Surgery in Manhattan. After all, they specialize in this sort of thing! So I searched on the insurance company's web site under the criteria "orthopedic surgeons" and "Hospital for Special Surgery." When the list came up I narrowed the doctors down by location, keeping in mind that I would be going for follow-up visits and knowing my family would be visiting me at the hospital.

Then I began calling the doctor's offices and crossing off the surgeons that did not specialize in ankle replacement surgery (many specialized in knee or hip). The list was finally narrowed down to three doctors and one of them didn't have an appointment available until March 2011. Of course that was too far away so I made appointments with the other two.

On August 20, 2010, my husband and I sat down with Dr Ayal Segal for a consultation on total ankle replacement surgery. He went over the various options that were available to me, from having a cadaver part put in, to having the ankle joint "stretched" with a surgical splint, to ankle fusion.

Having a cadaver part put in is a very experimental procedure and Dr Segal would have had to refer me elsewhere to have it done. This procedure didn't really appeal to me; I wanted something more concrete. The splint would stretch my joint and buy me 2-3 more years before I would have to undergo the replacement surgery. I didn't want to have to have surgery now and then again 2-3 years from now, so that procedure was out. Ankle fusion would basically render my foot motionless for the rest of my life and I would have to wear special shoes. Arthritis would most likely set into to the knee and hip joints of the same leg earlier on because I would be walking differently. The good thing about this procedure is that it would only be done once; I would never have to have surgery on my ankle again. But I didn't like the thought of never moving my foot again and having other joint problems due to the fusion. So then it came down to replacement.

Total ankle replacement is a relatively new procedure but within the last 10 years the technology has come a long way and the success rate for patients has improved. With the replacement I would be able to do everything I've done before, with the exception of high-impact sports such as running and tennis. But I would be able to walk around my neighborhood again, hike with my family, use my elliptical and Wii Fit again, and do so many other things that I haven't been able to do in over a year. Dr Segal told me I am an excellent candidate for total ankle replacement. I'm young, thin, healthy and active. If I were 20-30 years older I would have to have fusion; replacement would not be an option for me.

My husband and I felt the consultation went well. Dr Segal answered all of our questions, layed out all of the facts regarding the options available to me, and didn't pressure us in any way toward a particular option. He had done many ankle replacement surgeries previously and specialized in complex reconstruction of the ankle. He would do my surgery at North Shore Glen Cove Hospital. This was not initially the hospital I had wanted to have the surgery done at but I decided that the surgeon was more important than the hospital. Not to mention the hospital was only a half hour from my home, whereas the Hospital for Special Surgery in Manhattan would probably be over an hour away.

I knew this was what I wanted to do and I felt comfortable with Dr Segal. I made the surgical appointment for October 6, 2010, and canceled the appointment I had made with the other orthopedic surgeon.

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