Sunday, February 15, 2009

Whacked

Ankle deep in loose sand, I looked at the descent before me and at the beach beyond and knew I couldn’t do it. Instead, Roger and I turned around and went back to the house. I wanted to walk on the beach with my grandchildren and identify the barnacles and crab shells and seaweed; after all, we’d put six months of planning into this vacation, and I wanted to be part of the action. Even the slow ascent up the stairs couldn’t crack the denial. Something was wrong with my legs and I was the only one who couldn’t, or wouldn’t, see it. I was now an observer of life.

Behind the scenes, the kids ganged up on me, giving Heather the assignment to find a doctor and get an appointment for me. Heather is Jordan’s wife, a gift to our family, and we all love her very much. She convinced me that even if there was nothing wrong with my legs, I should have a confirmation from a medical expert. I agreed and she made the appointment. Jordan came the Sunday before Thanksgiving to drive me to their home in LaVerkin where I would stay until Roger came Wednesday for the holiday. My appointment was Monday.

We waited a long time. Finally we were taken to an examining room, and in a few minutes, a nurse took me to x-ray my knees. Then we waited for the doctor, Scott Parry. He came in, talked to us for a couple of minutes and then began to tell me about my knees. He saw bone spurs and arthritis in the joints, but very little cartilage. This did not make me a candidate for a new procedure that would simple plump up the cartilage with injections and restore the cushion between the fibia and the tibia. There was no alternative but surgery. I’ve had major surgeries before and always bounced back, so I wasn’t concerned about that. I’m essentially a very healthy person. Dr. Parry told me that his mother had this surgery several months ago and was able to go on a long bike ride and a hike with the family. I was sold when he said I would have 80 percent mobility and that I’d get my life back. Oddly enough, I have never experienced much pain in my knees. Mostly my muscles have hurt, preventing me from standing for long periods of time or from walking very far. Dr. Parry identified it as compensatory pain, because the muscles were trying to compensate for what the knee joints could no longer do.

Since I have injured my left knee so many times, I decided to have that surgery first. The doctor does seven surgeries every Tuesday, but the earliest date available on his calendar was two months away, January 20. He works two ORs at once so he doesn’t waste time. As the secretary wrote in my name in the last blank space and I realized it was inauguration day, I thought about inaugurating a new, more active life. I was given a pre-op appointment, and scheduled for an orientation a week before surgery to learn about what would happen and what to expect from the procedure. I began counting down the days.

On January 7, I met with Bruce, the physician’s assistant, who wrote “YES” on my left knee with a medical permanent marker, and gave some instructions about medications and other preparations for the big day. I would come to Jordan and Heather’s house Monday and wait for a phone call from the doctor’s office telling me exactly when to arrive at the hospital Tuesday. I went ahead and scheduled my post-op checkup and pre-op for the other knee on the same day, Feb. 4. There was one last spot on the surgeon’s calendar on Feb. 17, so I took it. I was reluctant to wait any later in the spring because of the danger of pollen allergies interfering.

Bobbette and I did our visiting teaching on January 12 and then she took me to lunch, since it’s my birthday. The next day I went to St. George with my friend Faye, and Heather joined us for the two-hour orientation session at Dixie Regional Medical Center, River Road campus. People from several departments came to talk to us about medications, the hospital routine on 4-West where we would stay for four days, and post-op therapy. We were given a foil-wrapped surgical sponge to shower with the night before surgery. They gave a physiology lesson on knee joints and passed around a model of what would be placed in our legs. It was heavy. One of the fascinating factoids I learned is that the bone, which is porous, sends out feelers or tentacles into the porous material of the artificial joint and bonds with it. I also learned that my new knees will set off security alarms in airports, but I will be given an ID card that will allow me to go through the “handicapped” security line and be wanded separately. A pharmacist talked to us about coumadin, a blood thinner we would have to take for two or three weeks after surgery. I was fascinated and not grossed-out at all by everything I learned. Heather was eager to learn about it since she hadn’t been assigned on 4-West very much.

Roger and I went to a website Elin recommended to look at an animated interactive video of the surgery. Roger almost fainted, but I was fascinated to learn that a saw, mallet and drill are involved. I was detached somehow, not associating with my knee the things I saw in the video. I had seen the surgery in sketches on WebMD, but this was more detailed. Apparently, technology has made knee replacement surgery a more exact science. A computer analyzes patient x-rays so the doctor knows exactly where to trim bone and drill the holes to receive the prosthetic. It figures the “Q” factor and tells the doctor what angle to install the prosthetic. “Q” is for quadriceps, the muscle on top of the thigh, and in men and women it’s different.

I went confidently to LaVerkin. The call from the doctor’s office instructed me to come in at 11:45 the next morning. I was sixth in line. Roger and Jordan gave me a blessing, and I felt my confidence justified.

The surgery is done with the knee bent at a 90-degree angle. A tourniquet on the thigh cuts off the blood supply so there’s less blood loss. After making an incision and pulling the kneecap aside, the doctor disconnects the joint, trims the tibia and fibia of bone spurs and arthritis damage, and then using a saw, prepares the surface of each bone for the prosthetic device. He drills holes in each bone to accept the device, then fits a sample device in and bends the knee to see if everything is going to fit. Removing the artificial device, he fits the prosthetic in place with special bone glue. Then he puts the kneecap back in place, stitches up the dermal layers and closes the incision. In my case, I had 23 staples. He told me later my surgery took 90 minutes. I was wheeled into the operating room at 2 p.m., had spinal anesthesia and some supplemental ‘happy juice’ to make me forget.

Having had major surgeries before, I dreaded recovery from general anesthetic. It leaves you groggy for days. The anesthesiologist gave me the choice of spinal or general. He said two-thirds to three-fourths of joint replacement patients choose spinal because they can wake up and be alert right away. It’s true. I was awake in recovery at 4 p.m. and ready to get on with my life. I suffered minimal nausea, but nothing serious. There was a drainage tube in my leg, a catheter, and – incidentally – a new cell phone. Jordan and Roger had gone out and signed us up on Jordan and Heather’s plan. They installed all the family phone numbers so I could speed-dial everyone. Nice.

On 4-West, patients have the best food in the hospital, prepared by a personal chef. We had breakfast in bed only on the day after surgery. After that we were up in a wheelchair or walker going to meals at 8, 12 and 5, and to morning and afternoon therapy sessions. A guest or ‘coach’ is welcome to have meals with the patient. Within 24 hours of surgery I was on a semi-recumbent elliptical machine for 15 minutes – my left knee felt great, but my right knee began to suffer with the pedaling action. I also had mat exercises to increase the range of motion, and for six hours a day I had to be on a motion machine that kept the knee flexible. I didn’t mind that, but my short legs don’t really fit in it. The doctor said some people walk out of the hospital four days after surgery and rehab at home without another problem. I wasn’t one of those. Medicare allows for 20 days in rehab every quarter, but since I had other insurance as my major coverage, and since I was planning to have the surgeries so close together, we decided to allow ten days for each knee. In the end, my insurance only allowed nine.

Elin came Friday morning and she was really a godsend. I realized soon after I got to the rehab facility that I brought all the wrong things. She went out and bought what I needed and went to therapy with me and was a cheerleader all the way. Jordan and Heather came that night with a beautiful bouquet of yellow and lavender tulips. Jordan downloaded Skype on my laptop so we could talk to Jen on the internet and see each other. We called her that night and they showed her my room, my bandage, the flowers and everything.

I was so excited to see Roger the next day for the first time in a week. He couldn’t stay long, but the kids engineered an escape to go out to lunch. We chose a Chinese place on the other side of town. Getting me into the car wasn’t easy or painless, but I made it. I had to go to the bathroom while I was at the restaurant, and I learned a lot about bathrooms that aren’t handicap-equipped. My fortune was hilarious, considering my helpless state: It would be wise at this time not to seek too much help from others. (Elin framed it and brought it to me the next day.)

Jordan and Heather brought me a toy to cheer me up – a purple toucan that sings two different operatic selections when you squeeze its tail, and the mouth opens to reveal a flashlight. It gave me endless amusement. I also enjoyed my new laptop computer which helped me stay connected.

Another somewhat amusing aspect of the rehab center was the food. “It’s very institutional,” sniffed the cook at the hospital 4-West unit. She was right, and although some of it was good, some was very bizarre. One side dish that sounds weird but was actually good was chopped celery and diced pears poached in milk. Since I was on coumadin to head off blood clots, I was supposed to avoid foods high in Vitamin K, such as lettuce and other dark green leafy vegetables, asparagus, peas, etc. One night, however, I was served a chef salad – lots of lettuce with a couple of pieces of tomato and some chopped cheese and ham. The side dish was a side salad. Really. I couldn’t believe it.

Elin and I had some good talks together and I was sad to see her leave on Tuesday. However, Heather came and spent the day with me on Wednesday, going to Walmart, taking me out to LaVerkin for lunch and a nap in the best sleeping chair ever – a new chair-and-a-half leather recliner they just purchased for their home. I could almost get my own foot in and out of the car. After cheering me on in rehab, she helped me have a shower and wash my hair. Then she lotioned my feet, curled and combed my hair and made me feel fabulous.

Jordan came Thursday and Friday nights to watch the new DVD Jen sent for my birthday, The Great Race, my favorite comedy. On Thursday I found out that my insurance wouldn’t approve the number of days the therapists wanted me to stay at the rehab center. Roger came again Saturday, and we went out to dinner at The Olive Garden with Jordan and Heather. By now I was able to get my own feet in and out of the car. After morning rehab on Sunday, the director of therapy brought me a number of canes to choose from – pink paisley, etc. I chose a black one, confident that I wouldn’t need it long enough to make it a fashion statement. Then Roger brought me home. On Monday afternoon I was in rehab in Richfield, where I went four times a week for the two weeks I was home.

Tomorrow (Feb. 16) we are headed for St. George again, and I report to the hospital at 7:15 Tuesday morning. Stay tuned.

1 comment:

jwise said...

I'll admit I had to skip the paragraphs describing the surgery. UG. There is a GOOD REASON I'm not a doctor!! Anyway, I am glad you are doing well now after the second one. Just keep working, and eventually walking, and you'll have your life back! :)