possible Drs appointment cancellation/ postponement

Who could have thought my Drs appointment next week with Dr. Saliman on my knee would be affected by an out of control wildfire?  Are you kidding me?  My MRI disc was supposed to arrive Monday but tracking says it's delayed "by weather conditions" although it is in LA.  

Dr. Saliman's office on Sunset Blvd is literally one block away from a level 2 fire evacuation zone.  Level 2 means "get ready."  Level 3 means "go."  

I've been waiting for this appt for 2 weeks but some people in LA have obviously far more serious problems.   Assuming I get a meniscus repair, it will take 18 mo to get back to elite level.  Really not even enough time to get ready for '26 if my surgery is delayed much past Feb or March.  

We're about 36 hrs away from a major winter storm, and for here in the deep south, a "major winter storm" means more than 3-4" of snow.   And, due to gross incompetence at the Chattanooga Capitol Toyota dealer's repair shop, I will be without my 4x4.  After a month and 3 different diagnoses, I was told the truck needed a new transmission and transfer case for $9000.   I called BS, took it to the local transmission shop and it was what I originally thought and told them from day 1.... an electrical short in the wiring.  Cost for a new wiring harness installed:  less than $600.   Unbelievable!

Totally sedentary except for my daily 20 pullups, ab wheel, pushups, and bicycle crunches with ankle weights.   My V02 max is gone.   Pool opens Monday.  

MRI with contrast 2/19

2/6/19 just after my previous knee surgery I went to the ER with a heaviness in my chest, I was worried about a pulmonary embolism or clot.   After D-dimer tested high they recommended a CT chest scan with contrast.  I went down to the hospital and picked up the report and disc of that test today.  The report was very detailed and basically said the word 'normal' about 10x in regard to my heart and coronary arteries.  No mention of blockages.  Not really very informative.  FWIW...  

CV Study - dietary LDL / carb intake

This is an odd one.   Purely an anecdotal case study, but references a cohort study on a subclass of individuals who are “Lean Mass Hyper-Responders” (LMHR):  

A recent cohort study of 548 persons on carbohydrate-restricted diets (CRDs) revealed inverse associations between triglyceride/HDL-C ratio (TG/HDL-C) and LDL-C change, and between BMI and LDL-C change, on CRD. This means leaner persons with lower TG/HDL-C ratios generally exhibit larger increases in LDL-C on CRD. Individuals with a particularly pronounced high LDL-C, high HDL-C, low TG ratio are termed "Lean Mass Hyper-Responders." This report provides a clinical vignette of a patient who exhibits the Lean Mass Hyper-Responder phenotype, with LDL-C as high as 545 mg/dl, despite normal pre-CRD LDL-C of 95 mg/dl and consuming a CRD with a high unsaturated/saturated fat ratio. Coronary CT angiography conducted after 2.5 years of extremely elevated LDL-C reveals no detectable plaque development.

This seems to correspond to the time when I was on the zero carb 'egg diet'. Although I didn't exactly meet the criteria for this phenotype -  LDL-C ≥ 200, HDL-C ≥ 80, and TG ≤ 70 mg/dl, I was close:

March '21 - mean body weight about 138.5 lbs, likely about 9-10% body fat, LDL - 203, HDL -59, TriG - 71.   Never had my HDL been that high at the same time my TriG were that low.   My Trig/HDL was never better.  

The case study "LM" was only in his 20s, but after having a LDL reading as high as 545, after two+ yrs on the diet, angiography showed he had accumulated zero plaque or heart disease.  

Back to square one.  It's all very individual and complex.  

Reviews and discussion

I was reading some online discussion on meniscus repair specialist, Dr. Saliman.  Seems like he is willing to tackle the tough and difficult repairs no one else will.  He has a technique called 'circumferential compression repair' which he wrote a paper on in '13.  

Here is some of the discussion I've read from his recent patients who've had surgery with Saliman in just the past few months:

"I had an extremely complex tear that was repaired by Dr. Saliman on September 5th (I’m 7 weeks post-op today). It required 11 stitches to repair and Dr. Saliman said he had to piece it together “like a puzzle.” I traveled from Virginia to see him after doing a second opinion with him because my local orthopedic doctors could only offer a meniscectomy... My physical therapist is super impressed with how I’m doing given being in a straight leg brace for so long. And after seeing the pics from my arthroscopy, she is also amazed that Dr. Saliman was able to repair my tear so well (she mentioned she had never seen a tear so “wavy” before)."

"He said same thing about my repair, it was “like a puzzle” :)))...   I counted 6 stitches. 

"08/26/24 had my ACL and meniscus repaired by Saliman. He really cares about ur success. Told me 85% chance of success.  He told me my meniscus was one of the worst torn ones he's ever seen ...so longer surgery (2 hrs). High character guy. BS free.  Used BioBrace Graft reinforcement & Regeneten reinforcement grafting to the medial meniscus repair."

I think Saliman is a good choice from what I've read but it won't be cheap.  I'll probably pay several $K out of pocket, but that's ok.  My insurance will still pay 60% (for out of network) and I have a $7200 out of pocket max.   His use of new technology (i.e. MISHA knee system, BioBrace, Regeneten, etc...) demonstrates he is very current, and he shows meticulous attention to detail.  So, I think he might be able to help me.   

Hope the new year brings a new knee.  Will be a long recovery.