The (nearly) bionic woman

I haven’t written much about surgeries lately. Well, truth be told, I haven’t written much about anything lately. But certainly not about surgeries. Despite the double-digit number of surgeries I have had in the last five years, I don’t like being cut upon or tweaked or refined. I’m good with my rough edges. My body has other ideas, however.

At the beginning of this year I had reached my limit of tolerance for the carpal tunnel pain & suffering so I consulted a well-respected hand specialist and got a nasty surprise. In addition to carpal tunnel, I also had cubital tunnel syndrome (I’m an overachiever that way), so the no-big-deal surgery to correct the issues in my right wrist morped into a full-blown ulnar nerve anterior transposition. It looked like this:IMG_3829

Yuk.

Long story short, the ulnar nerve (which runs from one’s neck to fingertip) becomes dislodged and gets caught on the bony ridge of one’s elbow when one stretches or bends at the elbow. Once dislodged, the nerve needs help getting back in the right place. So, my surgeon had to dig a new channel for my ulnar nerve to lie in, then stitch the nerve into the muscle to ensure that it didn’t go rogue again. It was as pleasant as it sounds (not really pleasant at all). And the scar is about as pretty as you might expect (not really pretty at all). It’s a good conversation piece, though; I’ve been asked more than once if I had Tommy John surgery (do I look like a baseball pitcher?) or whether I won the knife fight. IMG_3837

Now that I am recovered from the fun & games of my arm surgery, it’s time to get back on that OR table and get myself a new knee. Yes, a total knee replacement at the ripe old age of 46.

Don’t be jealous.

I’ve been dancing around the knee issue for years. After two arthroscopies, a lateral release and minor ACL repair, a PRP infusion, and 11 injections of synthetic synovial fluid in the last 10 years, it’s time. The x-rays that show zero cartilage say it’s time. The grinding of bone on bone say it’s time. The uncertainty of being able to get up from a crouched position say it’s time. The increased pain, decreased mobility, and off-the-charts frustration say it’s time.

Sigh.

Big sigh.

I’m not looking forward to this.

That said, I am intrigued by the particulars of an artificial knee; the one I’m getting is cutting-edge. It uses a proprietary Oxinium (oxidized zirconium) on the femoral part of the joint, a PMMA plastic on the tibial side, and a stainless steel piece to add a little sparkle. That oxinium is pretty cool; it’s a metal alloy that once heated transforms into a smooth surface that is super resistant to wear & tear and is much lighter than the metal used in older versions of knee replacement devices. It is free from nickel but will likely still set off the metal detectors at the airport. Fingers crossed that the TSA person who gives me a pat-down is gentle (and cute).

The combo of Oxinium and PMMA plastic are the Wonder Twins of knee replacement devices. Rumor has it this combo can last 30 years. That’s important when one is on the flat end of the bell curve that represents the average age of a knee-replacement recipient. As is my custom, I’m way ahead of my peers in my medical needs. Like 20 years ahead.

Being the weirdo that I am when it comes to surgeries, I like to gather all the gory details about the procedure. I usually watch a youtube video of an actual procedure, too, but usually after I’ve endured the horror of the real thing. Here’s how it will go down: Amy doc will make a vertical incision, probably between 6 and 10 inches, on my bum leg. Once in, he will move my kneecap so he can get to the leg bones. He’s going to cut my femur and tibia (if you’re strangely curious as I am, may I suggest that you don’t google “orthopedic bone saw?” That’s just creepy. The fact that such tools are available for purchase on eBay is even more creepy). He promised to measure twice and cut once. (Because the pieces that comprise an artificial knee come in some 90 sizes, I hope he measures more than twice!) Once the bones are cut, he will shape them to accommodate the new pieces that will make up my bionic knee and will attach the pieces to the bones. Then he will attach the parts to the kneecap, using bone cement. My doc told me that waiting for the cement to dry takes nearly as long as the rest of the procedure. Then he will sew me back up and once I’m awake and somewhat coherent, I’ll be off to my hospital room.

Most patients stay three nights in the hospital, but I’m already hoping to ditch out early. I’ve spent enough nights in the joint. I’m fortunate that my doc has a swanky surgery center not far from my home. There are only 5 rooms, which is good because I have no business mixing and mingling with the gen pop in a regular hospital. I hear a lot of people get really sick in hospitals. 

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It’s been too long

way too long
jaysonpotter.com

No, I haven’t fallen off the edge of the earth. And no, I haven’t been too busy playing tennis to blog. Sadly, tennis isn’t in my plans for the near future, and by near future I mean several months. Almost 3 weeks out from my knee surgery, I can say that without crying. I’m not happy about it, but frankly, as bad as my knee was and as hard as the recovery has been, I can’t even imagine playing. I’m glad the US Open coincided with my convalescence; it kept me entertained and still, which is a tall order for this busybody.

I expected recovery to be hard, but I didn’t realize how time-consuming rehab would be. I do physical therapy and a modified workout 5 days a week, with one day of just PT and 20 minutes on the bike and one day of rest & recovery to round out my week. The rest & recovery day is the hardest for me. I love the free time early in the day, but by about 2 p.m. I’m antsy and jonesing for a good sweat.

Been spending more time than I ever have, ever in my whole life, sprawled on the couch in front of the TV, exhausted and spent. After getting my kids off to school, doing PT and the modified workout, running an errand or two and feeding myself, I’m done. All I can manage is to splay out; lifting my arm to point the remote at the TV is a big chore. Such a strange state of being for me. I’m trying to be patient, and of course being so so so tired helps in that pursuit.

The good news is that progress is being made. While the PT is brutal, and forcing my knee to do things it most definitely does not want to do is hard work, I can see real improvement over the previous week. I’m still under strict orders to let the pain be my guide, but I’m pushing myself a bit more every day. Yesterday the big accomplishment was step-ups (stepping up onto a low bench and forcing my knee to bend as if I were going up a flight of stairs). At first, the bending motion was excruciating, but by about the 20th rep it got easier. Today it was a modified squat with the big rubber ball. Real squats, which were a big part of my life pre-surgery, are off the menu for me, forever. Or as long as I have this cartilage-deficient knee. If I choose to get a new knee, I can squat all day long, but with this old clunker, no squats and no lunges. If I linger too long on the fact that I can’t do two of my favorite exercises–in addition to the moratorium on tennis–I’ll get very sad, so I’m zipping right on by those topics. Gonna try and focus on what I can do, and see how far that gets me. For now, the list of things I can do is pretty short, but I’m doing those things with less pain overall, so I’m calling that a win. I have a newfound respect for anyone who lives with chronic pain. Knowing that mine is temporary is comforting (although 3 weeks is a loooong time when you’re in the thick of it!).

 


Whatever the trouble…

“Whatever our individual troubles and challenges may be, it’s important to pause every now and then to appreciate all that we have, on every level.” — Shakti Gawain

In my case, the trouble was a messed-up knee. It was all kinds of messed up. As The Hubs so astutely pointed out, it’s been messed up ever since he’s known me, which is some 20 years. Day after day of running, jumping, squatting, and lunging was taking a heavy toll, as was years of escalating stair-climbing, box-jumping, and jump-roping, all in an attempt to achieve and maintain a level of physical fitness that “they” say thwarts disease and ensures a long, happy life. Well, I blew the thwarting part, and despite my best efforts, disease found me, but I won’t let that discourage me from my pursuit of the kind of fitness that fires off a slew of endorphins and allows me to do things like easily hoist a 40-pound bag of dog food into my shopping cart.

My pursuit and its inherent impact and repeated pounding has caused me some big-time, ugly trouble in my knee. Seven years ago, I had enough of the pain and grinding and had it scoped. A thorough cleaning of the underside of the kneecap and a few tweaks to a ragged meniscus breathed new life into my beleaguered joint, and the running, jumping, squatting, and lunging, et al, resumed. However, one scope can’t hold me for life, especially when you add in a borderline obsessive tennis habit. Fast-forward to now and you get a knee that is one big mess.

I’m not one to slow down, take precautions, and tread lightly. I’m not a fan of admitting weakness and succumbing to pain, either. But sometimes our bodies and the universe have other ideas, and this busy-body was felled. A quick consult with my favorite orthopedic surgeon revealed that it was time to stop the madness and sort out this mess. An x-ray and MRI confirmed that there were some big problems that needed to be fixed: chondromalacia (denigration of the cartilage under the kneecap), lots of inflammation, and a bad case of patellar maltracking. Another scope as well as a lateral release were in order, preferably sooner rather than later.

Oh, goodie: more surgery.

I’d rather take a beating than go under the knife, again, but I’d ignored this hot mess as long as I could. Just the scope would have been no big deal, with a couple of weeks recovery, but the lateral release meant a much longer, more involved recovery. And, in typical me fashion, the situation was complicated even further by a surprise once the surgeon got inside my knee: a few tears to the meniscus, a couple of small tears to the ACL, and the biggest surprise of all: the complete lack of cartilage under the kneecap. That’s right folks, the cartilage was gone, baby gone. Hmmmm, no wonder my knee hurt.

Here’s what a normal kneecap looks like: lots of healthy white cartilage on top, all shiny and smooth like a cue ball or a full moon, with no bare spots or blank spaces.See that shiny, white segment of cartilage on top, just above the tool that’s been inserted into the knee? On me, there is none. Instead of that glossy white section of healthy stuff, there’s nothing. Oh, bother.

 

There is hope that the PRP can help regenerate some of the missing cartilage. But as the oh-so-wise Peggy Hill once said, “You can hope in one hand and poop in the other, and see which fills up first.” No, there is no guarantee my cartilage will regrow, and the more likely scenario is a knee replacement at some point in the not-so-distant future. Uh, huh: yet another surgery.

But not for a while. I’m going to tuck my head and soldier through this recovery. I’ll take solace from the fact that my doc and his PA were surprised by how well I’m walking, even thought I’m impatient to be healed. One week should be enough, right?? I’ll relish hearing my resident experts say that most people are still on crutches and pain pills at this point while I’m hobbling and grinning & bearing it. I’ll feel the swell of pride in knowing that my no-cartilage kneecap lives out loud in my doc’s and his PA’s minds: “Oh, yeah, you…the one with the gaping hole where smooth cartilage should be. Cool.” Physical therapy isn’t my favorite, and being sidelined from the things I want to do is even less so, but this is where I am right now. So be it. PT, limited mobility, pain, swelling, and stiffness will be my constant companions for a few more weeks. Then, like a little chick hatching from its shell, I expect my new, improved knee to make its way into the world, no longer still and helpless but bending and flexing and strengthening. As Marie’s challenge reminds me, I can appreciate that, on every level.

 


Surgery update

The knee surgery went well yesterday. Got up at the crack of dawn to truck on into the Medical Center and was at the surgery center at 6:10 a.m. Sherpa Amy came prepared with a rollie bag full of projects and snacks, even a picnic lunch. She reminded me to tell the doc that morphine is not my friend via IV but intramuscularly in the behind works fine. She brought me home while Trevor filled my prescriptions, then helped Macy with her knitting. I would love to sing her praises even more but don’t want to risk someone else wanting to partake of her medical concierge services. I’m selfish like that.

After filling out the requisite paperwork, I was escorted back to anesthesia land, one of my favorite places. The anesthesiologist was flat-out awesome. He looked about 25 and played football in college. Based on the size of his thighs, I’m guessing he special-orders his scrubs. He held my hand and said he was taking me to the prom–his little joke to distract me from him inspecting my veins, which are combative and uncooperative on a good day. One quick poke to my left hand, and my prom date was in.

My surgeon came to visit and to double check that I did want the lateral release procedure in addition to the arthroscope. I said yes, please. Ever since I learned that my kneecap was dislocated, I’ve been creeped out and was ready to get it back in line.

After our chat, I got half of my anesthesia cocktail but had to wait for the other half until I got into the OR. I had to haul myself up on the operating table, which would have been difficult if I’d consumed the entire cocktail. I vaguely recall being in the OR but don’t remember getting on the table.

A couple more pics of the lateral release:

Next thing I know, I’m waking up in recovery and fighting hard to keep my eyes open. I’m weird about wanting to prove that I’m ok and ready to go home. Even when I know in my heart of hearts that I should stay, I want to go. Kinda sounds like the basis for a country song. I’ve got an ace bandage from mid-calf to a several inches above my knee, and lord knows what’s under the ace bandage. I’m not all that curious to see. I know that there are 3 incisions, all of which are stitched closed. The ace bandage can come off tomorrow, and I’ll get a look at the stuff inside.

The good news from the surgeon: both procedures were successful. The bad news: I have no cartilage under my knee cap. None. Nada. Zip. So while my kneecap is realigned again, I’ll still be dealing with the pain. Hopefully not as bad as it has been; I’m optimistic, or delusional, either one fits. Dr Alani also said that even after the scope and the lateral release, I can’t do squats or lunges. Ever. Sigh. That makes me quite sad because those are things I actually like to do. I’m weird that way. And stubborn, too: the fact that he says I can’t do it incites me to try. My handlers are going to be hard at work on this one.

Because there’s no cartilage under my kneecap, I will most likely need a knee replacement at some point down the road. Add that to my list of things to do.

Today I have 2  goals: to take my twice-daily antibiotics without letting myself be transported to the awfulness that was 267 straight days of antibiotics after my post-mastectomy infection. I can do this. The second goal is try to bear some weight on my right leg and see how the knee responds. My guess is that its response will be angry. I’m tempted to start weaning myself off the pain meds, but I can hear my handlers protesting that it’s too soon, and that I’m going to need the meds even more after I try to put some weight on my bum leg. But the Lortab makes me itchy and spacey. I can’t take anti-inflammatories because of the PRP he injected into my knee. The autologous injection’s purpose is to stimulate the inflammatory response that helps our bodies heal. Anti-inflammatories short-circuit that response. Same for ice: I’d like nothing more than a big bag of ice on my knee right now, but it too can hinder the PRP’s success. So no ice, no OTC meds for me.

The surgical center staff talked a lot about the pain associated with the lateral release, and I smiled knowingly because I’ve been through so much worse. All I have to do is toss out the words “bilateral mastectomy,” “nosocomial infection,” “multiple tissue debridements,” and “DIEP reconstruction,” and the nurses realized that it’s all relative. An IV in my hand, a few little incisions and some cut connective tissue don’t scare me. Looking back on my previous surgeries reminds me that while it’s a hassle to hobble and a drag to be on crutches, it’s a piece of cake comparatively speaking. If one good thing has come from all the surgeries I’ve had it’s that I’ve learned to be much more patient with the healing process — a big step for a busybody like me. Instead of gnashing my teeth because I’m on the DL again, I’m sending happy, healing thoughts to my beleaguered body. As my sweet survivor sister Jenny reminds me, “It’s temporary.” Hopefully I’ll be recovered in time for some fall tennis, when the sun-soaked TX weather eases a bit.