Wednesday, September 9, 2020

The new knee

We are Borg.  You will be assimilated.

Aug. 19, 2020 I joined the Collective.  In Dallas, I underwent a total knee replacement surgery, aka TKR.  It has been an interesting journey.

It all started when I tore my medial meniscus in a church league softball game, somewhere around 2006, I think.  It was scoped, which seemed to fix things, but I was warned it would become arthritic.

Boy howdy, did it ever!  Ultimately I had tri-compartment arthritis, bone on bone medially.  This was making everything more difficult, especially when compounded by the pair of large cysts in the knee joint.  The cysts were restricting movement, and the smaller was causing a lot of nerve pain.  The cysts of course were driven by the arthritis.

I could've tried to just have the cysts removed but at least two orthopedic surgeons indicated it would likely return fairly rapidly, due to the arthritis, unless the knee was replaced.  Not wanting to undergo multiple surgeries for the issues at hand, I  went to see the surgeon recommended by both the other guys I had spoken with.  Dr. G. is an orthopedic oncologist.  No, I do not have cancer, but he is extremely experienced and skilled at digging unwanted things out of patients bones and joints.  He also does a lot of joint replacement and reconstruction, and revision joint surgery.  Dr. G. said he would not only remove the cysts, he'd do it during the TKR, and from the "front", eliminating the need to have a second large incision on the back of my knee.  YAY!

A date for surgery was set, rather far into the future, due to the Covid19 restrictions in place at the time.  I would've liked to have the surgery sooner, but coordinating family schedules, and Covid19, meant a longer lead time.

OEM Knees
Above is the last photo of my original equipment knee.  Hairy legs and all, because they don't want you shaving before surgery.  Apparently not shaving lowers the bacterial count on the skin...and also keeps you from nicking your leg with a razor.  I remember being wheeled down a hallway toward surgery, thinking "Last chance to bail on this, kiddo!"  And then I woke up, in Recovery.  The pain, which was NOT well managed (my primary gripe with the hospital, really), was significant.  I try not to bitch about pain, but when it's clocking a steady 8-9 out of 10, there is a problem in my book.
There's a new knee under there somewhere.
Two days in the hospital, connected to the green legging contraption.  It's a pressure cuff affair, designed to keep pushing blood around, so you don't get blood clots.  It would've worked better if the staff had remembered to turn it on after every time I got up...but in the end it worked ok, because I didn't develop any unwanted blood clots.
On the day following surgery, after having been up and walking on it, the LNP came by and removed the surgical dressing.  Other than being swollen, the knee doesn't look too bad.  All the purple lines, and the blotchy marks at the near end, are register marks and the "Cut this one" autograph.  The LNP put on a smaller silver impregnated dressing which was a lot more comfortable.  In the picture below, you can see both teh dressing, and the post operative bruising.  Yes, by that point, my right leg was about twice the size of the left!
Rehabbing a TKR is a lengthy process.  The first thing they want you to do, besides walk on it, is to have you try to straighten the leg completely.  This is counter-intuitive to me, but at this point flexing your knee is less important.  If you can't force it straight, you'll always have a limp.

Twelve days after surgery, I went back to Dallas to get the 37 staples removed.  (Or was it 37 8x10 color glossy photos, with circles and arrows and a paragraph on the back of each one, explaining what each one was, to be used as evidence against us....?  Nah, must've been staples since it's not yet Thanksgiving, Arlo!) 
37 staples

No more staples!

Steri-strips to hold it all closed.

Physical therapy started once I got home.  At first they were coming all the way out to the house, which was nice, since long car rides were at best uncomfortable.  Now though, I tend to ride into town at do therapy at their clinic.  It's probably more productive there too, so in this case, more torture is a good thing.

Some of the PT is easy, some of it is hard, and until yesterday, trying to pedal the exercise bike was brutal!  But finally, after doing everything else required during therapy and being thoroughly warmed up, I was able to pedal in a circle!!

It may not seem like much, but it means the world to me.  I haven't been able to ride a bike without pain for at least 8-12 months.  Now, I'm not yet pain free, but I have enough flexion to pedal!  Home rehab can begin in earnest now!  My crank arm shorteners even showed up in the mail yesterday, so I will be able to adjust the radius of the circle on my own bikes.  Smaller circles are easier and less stress on the knees.

I will post future updates on the knee, as things progress.  In the meantime, if anyone is contemplating TKR surgery, and wants more info, feel free to reach out to me via the comments.  I'll try to get back to you.  

Saturday, May 30, 2020

The Bees Knees?

So, the left knee is healing well, at one month post-op, and I've been released from Doc's care/treatment.  Over the next month or two it should get back to normal.

That's a good thing too, since I'm pulling the trigger on the bad right knee in mid August.  It, and it's damnable cyst the size of half a banana are going away.

After X-rays, MRI's consults with surgeons and specialist surgeons and a second opinion, I have found a specialist orthopedic surgeon who is willing to replace the knee AND remove the cyst at the same time, and from the same incision.  I was so relieved when Doc G said, "Oh yeah, I can do all that in one surgery, easy," that I practically hugged him!

He comes highly recommended from the other two surgeons who are familiar with my knee problems.  And the general consensus amongst them all was that just replacing the knee probably would not resolve the cyst (it's too big).

And honestly, it's the cyst that is causing most of the pain and restricted movement.  It gets pinched every time I flex my knee.  Part of it seems to be impinging on the primary nerve to the lower leg, which makes life interesting... And just taking out the cyst without resolving what caused it in the first place is pointless, because it'll just come back due to the arthritis.

So say a prayer for me, and look out for future updates as I embark on the great adventure that is a total knee replacement.  At least it's getting me back in the gym lifting again, since Doc G said stronger is better for knee surgery.  Let's be honest though, stronger is better, period!

Thursday, May 7, 2020

If it's not one knee, it's the other!

A long time ago, (10+ yrs iirc) in a Metromess not so far away, I hurt my right knee.  Church league softball was to blame.  Surgery fixed up that medial meniscus, though Doc Killemquicker warned me that I would end up with arthritis in it.

FF>>> to 4 years ago, when the arthritis started getting bad, and I began favoring things to my "good" left knee, which had experienced a similar surgery in 1999.  All was good afaik, until this March, when I began to notice some medial knee pain in the left "good" knee.  It was wearing out.  The right knee had continued to deteriorate to the point that it is bone on bone, and I was just beginning the workup for a total knee replacement, when the quarantines hit and the .gov decided to ban elective surgeries.  Bugger all!

Now, picture this, it's Easter morning, 01:30 and a big line of storms is approaching.  I awaken, and decide to short circuit the dogs' storm fears by giving those big chicken Ridgebacks some calming treats.  I thought they were in the kitchen cabinets, but when I moved and turned, to look in the second cabinet, POP!!! OUCH!!! My good knee went out.  Managed not to scream and awaken Dave, and hobbled back to bed, only to awaken in time for Easter service barely able to put weight on it.

The next day, Doc Killemquicker diagnosed a torn meniscus in the good knee.  MRI confirmed just how shredded it was.  Since two weeks ago, they lifted the elective surgery restrictions, I decided to get it fixed last Thursday (it was making walking any distance at all fairly painful).

Surgery went well, despite the crazy Covid19 restrictions, and I only experienced my first bout of post-anesthesia nausea.  No pain.  Yay!  I left for home with Dave driving, and my knee with a ton of surgical dressing wrapped around  it.  Mind you, there are only two quarter inch incisions (arthroscopic) in my left knee and they are steri-stripped shut.

Being a smart patient, albeit a stubborn one (so named by Doc Killemquicker!), I behaved and spent the rest of the day in bed, legs elevated.  I had stopped all NSAID consumption the week before, except low dose aspirin as ok'd by Doc.

I noticed, when I sat down in the bathroom, that my knee went squishy-gurgle on the lateral side (kneecap incision site).  It did this 2-3x, when I would transition to sitting.  I also began to notice the surgical dressings were getting heavy and pulling away from my knee...  Turns out by 18:00 that night, they were soaked thru with blood.  Hmm....that's never happened before.  So I changed out the dressings and wrapped everything up again.  By 22:00 it had happened again.  Things were simply not wanting to clot.  It was too late to call Doc's office, and too far to drive to an ER.  Besides, the flow, while steady, wasn't arterial or anything.  By 06:00 Friday, it was soaked thru, and messing up my bed. Blech! Dressing change again!

Got ahold of Doc's office at 08:00, and after explaining I had needed 4 dressing changes, Doc said to drive into the Metromess.  Mind you it's usually a 2.5-3hr drive depending on traffic.  Dave and I left just a few min after 08:00.  By 10:00, I was waiting to see Doc, having already soaked this latest dressing thru in 3 hrs, and dripped blood all over my floorboard in the truck!  I conservatively estimate blood loss at one pint by this point in total.  (I've been donating blood for most of my adult life, so I am well acquainted with how I feel when a pint low.)

Doc Killemquicker peeled off the dressing, and revealed a narrow but steady stream of blood.  After 3 attempts to staunch the flow with steri-strips, he conceded defeat, and said,"You're gonna make me stitch that, aren't you?  You know, I've only had two other bleeders in 33 yrs of surgeries.  One was due to a rare medication side effect, and the other stopped with steri-strips.  But, no, YOU have to be difficult!"  He put in two stitches there in the office, which didn't solve the problem.  So he took one out, and used a different style of stitch, one that managed to miss ALL the areas numbed with lidocaine...I don't think Doc saw the bad faces I was making!  But finally, it stopped bleeding!

But now Doc was concerned over infection risks, since we were 24hrs post-op and your suture window ends around 12hrs.  So I also got a round of horse pill sized antibiotics, and he said he'd come in on Sunday afternoon to remove the stitches and check for infection.  You ever heard of a doc who would give up his Sunday afternoon to see a patient??   This is one of the reasons I am willing to drive so far to be his patient!

No more bleeding.  Sutures removed last Sunday.  No infection. No pain in the joint.  And, I get to drive in again tomorrow for my regular surgical follow up appointment!  And then next week I get to restart the TKR work up with a specialist in Dallas, who was recommended by Doc Killemquicker.

At least now, Dave has restocked our supplies of medical dressings!

Thursday, February 6, 2020

28*F and a Surprise at Dawn

Woke up before dawn this morning, during our cold snap.  The house was cold, but that's to be expected when you don't run the furnace.  Dave said there was a surprise outside.  I was expecting an ice storm. 
 So this was better than that, at least, though Ruby and the hens might disagree.

The hens got some scratch to warm up with, and Ruby got a flake of hay to start her day.

There was less than an inch, and the roads look to be clear.  That's good, because my tires on the Tundra are not quite slicks, yet!