Monday: Pre-Op Consultation
Lots of fighter pilots seem to know Dr Dugas as well. I couldn't help but wear an IMWC shirt. I want to run again and I thought it would reinforce that.
My High Tibial Osteotomy (HTO) complete. A few stainless steel parts and a chunk of cadaver bone is all the recipe calls for!
My new graft of cadaver cartilage nestled in place on the medial femural condyle.
I'll finish with one more Far Side cartoon......because all setbacks are relative!
My home for the better part of this past week.
Pre-op consultation at Andrews Sports Medicine in Birmingham, AL went well but started out confusing. Dr Hasty (my surgeon here in Greenville) had already discussed my situation with Dr Dugas and it seemed pretty clear I was to have a High Tibial Osteotomy (HTO), where they cut a wedge out of the upper tibia about 90% of the way through the bone and then fill it with a donor wedge bone and screw it together at a new angle that relieves the asymmetric pressure on - in my case - the medial side of the knee. An allograft of donor cartilage would then be inserted into the bare spot on my femur. But a younger doctor came in to the holding room before Dr Dugas did, and he was telling a story of an immediate autograft (cartilage taken from my own bone), and a 2 week wait as it grew in a Petri dish in Boston, at which point I would go back down to Alabama and have a second procedure to have the graft inserted in the femur. 2 separate surgeries, 2 separate trips to Alabama, and a longer more frustrating process?! Oh, hell, no!
Lots of jerseys and autographs on the walls of Andrews Sports Medicine and Orthopedics.
Lots of fighter pilots seem to know Dr Dugas as well. I couldn't help but wear an IMWC shirt. I want to run again and I thought it would reinforce that.
But when Dr Dugas came into the room, all that was erased and Angie and I both breathed a sigh of relief. We were elated that Dr Dugas was on the same program Dr Hasty and I were. The only issue at this point was that BCBS may not cover the graft part of the surgery. But I liked Dr Dugas from the get-go and he had me at "I will treat your knee as if it were mine" and make a call during surgery to add the graft if it looked necessary regardless of what my insurance company said. Which is cool, because I probably didn't want to be brought to consciousness to sign a waiver of consent at that point. I felt like I was in the best hands with Dr Dugas, and he was very confident that I would be able to run again after a long recovery period of 6 months to a year.
To insert the cadaver allograft of cartilage in my femur they drill a pocket out of the medial condyle and then insert the graft into the pocket. It's a press fit. Because there's so much curvature to the site, the graft has to be measured and shaped precisely to fill the void perfectly. I have no idea how they figured out how to do this kind of thing.
Later that afternoon Angie called BCBS and pleaded our case for them to cover my graft for over an hour and a half. They finally made a decision to go ahead and cover it in full while she was on the phone with them, and I'm sure Angie's persistence had a lot to do with it. What a relief!
Tuesday - Surgery
Surgery was at 3 pm and admittance at 1, so we had some time to kill that morning.
I considered showing up for surgery labeled like this. Dr Dugas has a good sense of humor, but I thought I'd save the jokes for later.
So we went to the zoo. My last footsteps for a long while took me around pens of elephants, tigers, and spider monkeys. Once admitted, there was the usual long wait and I was finally wheeled away on my gurney around 3:30. Versed was added into my IV, and then a block was put in at the groin to numb the whole leg. The block would last through the night and keep 70% of the post-op pain at bay. As I lay there waiting to be wheeled into the operating room I entertained myself by poking my thigh over and over again. It felt like it was a Jell-O leg in place of where my usual leg was.
I considered showing up for surgery labeled like this. Dr Dugas has a good sense of humor, but I thought I'd save the jokes for later.
So we went to the zoo. My last footsteps for a long while took me around pens of elephants, tigers, and spider monkeys. Once admitted, there was the usual long wait and I was finally wheeled away on my gurney around 3:30. Versed was added into my IV, and then a block was put in at the groin to numb the whole leg. The block would last through the night and keep 70% of the post-op pain at bay. As I lay there waiting to be wheeled into the operating room I entertained myself by poking my thigh over and over again. It felt like it was a Jell-O leg in place of where my usual leg was.
And then off to OR.....!
The last thing I remember seeing as I lay on the operating table with an oxygen mask on my face....
After being brought back to the real world, I was carted off to my hospital room where I had been told I'd be kept for one night for observation. Angie was there and it was great to be back in her hands. Obviously I was under a ton of meds so I don't remember much of the next few hours except for just being sleepy. Angie slept on an extendable couch that looked horribly uncomfortable and we both tried to sleep the night away, but I was in some pain that would spike to a 6 out of ten every now and then.
My High Tibial Osteotomy (HTO) complete. A few stainless steel parts and a chunk of cadaver bone is all the recipe calls for!
My new graft of cadaver cartilage nestled in place on the medial femural condyle.
My pain meds were being supplied through a pain pump, and I believe the drug was Dilaudill. The pump is hooked to the IV and I have a little Jeopardy button I can hit to self administer a dose when needed. They set a timing period that I have to wait before I can have a dose (I think it started at 15 min), but other than this it was up to me on when to dope up. So I hit that damn button ever 2 minutes for hours! If it wasn't time to release the meds yet, it'd give this "Negative, Meds Denied" series of beeps that would just break you down, but if you waited the proper amount of time it'd have one single loud beep that was just heavenly to hear. My night shift nurse was named Tyler, and I really got to like this guy over my stay there. He recognized I wasn't getting the pain medication I needed and upped the timing interval to every 12 minutes. Now, I learned that he can't do that without permission from a doctor. So, when you're in pain and begging for meds and he says they're on the way it may actually be a while to find a doctor that isn't busy and get his approval. At this point I had no idea how frustrating that little rule was about to get.
Wednesday - Post-Op
I made it through the night okay though there were rough patches, and I was still hitting that pain pump button like Ken Jennings going for the Jeopardy one-day earnings record. But I hadn't peed yet and I knew two things about that: (1), I really did need to pee, which was good, and (2), I'm prone to stage freight in uncomfortable pee situations (there's a whole 'nother blog post on that buried somewhere in my blog) and, this time, if I didn't perform the consequences were going to involve humiliation, a man touching my wiener, and feeling violated. And this was bad.
Tyler now took on the role of Chief of the Pee Police, as me having a go was obviously priority number 1 (Sure, to them, but pain meds were still first and foremost to me!), and Angie was somehow deputized into their posse. If I didn't pee, they were coming for me. I grabbed my pee bottle, had them turn the faucet on, and kicked them all out of the room. After an intense struggle I got 100 mL. I was so proud. The Pee Police were not. They moved me to the edge of the bed where gravity might become a bigger player, left the room and I tried again. But it was like Greenville Utilities had shut off my plumbing. They came in and said the catheter word and I pleaded with them to stand me up and let me have another try. Now standing using the aid of two male nurses and in serious pain as everything flushed down my leg, Angie went under my skirt and turned the tap on. My tale must have been between my legs and in the way though. Nothing was coming out of me but dry, dusty humiliation. It was my humility vs the posse's frustration. I asked for one more shot at it sitting down and managed another 100 mL but knew it was futile.
Tyler ran an in-and-out catheter up my wiener and drew out a 600 mL bag of pee. It really wasn't painful at all. And I felt closer to Tyler than with some of my best friends after that awkward moment. I got back prone in my bed wondering if I should send the nice man flowers or a box of chocolate, and he introduced me to the day shift nurse that would take his place for the next 12 hrs. I think I slept most of Wednesday morning.
First steps with a walker, and of course, no load-bearing on the new knee. I love those post-surgery socks they give you at the hospital.
It was clear I wasn't going home today. The pain was not yet under control and I was still woozy, probably cuz I was soaking up all the nausea from the meds and leaving the painkiller stuff still in the drug. I know, just humor me.
I woke up around lunch to some food I was not up to eating. And the level of pain was a 6/10. The nurse went to get an approval to boost the pain pump meds to every 8 minutes. I laid there for 3 hrs mashing the Jeopardy button every minute, willing it to release its precious narcotics, all the while though hearing that 4 beep tune that meant' "No drugs for you! Wait longer!" Pain was now at a 9/10 and I couldn't stand it any longer. I called the nurse at the desk and begged her to give me something and Angie was now outside the room in a panic trying to get anyone to come in and help. My nurse came in finally and said she still hadn't gotten word from a doctor to approve upping my meds. I was now looking for anything.....morphine, whatever, just something to ease the pain even temporarily so we could figure out a new pain med protocol. She asked, "Well, what do you want me to do?" And if it weren't for all the pain and the fact that she seemed to be the only way to get me out of it, I would have unleashed a fury on her. Turns out I didn't have to cuz Angie was there and she's always willing to dig deep and let someone have a piece of her mind. Another nurse came in, or maybe she was PT, because she went straight to my leg brace and discovered one of the latches was too tight and was digging into my incision. Within 15 minutes of loosening that I began to feel a little bit better but not near good enough. The head nurse also came in and suggested switching to oral meds. Once we did so, all was good again. But it was a dicey 4 hrs. Angie and I made up with the nurse that was assigned to me and life was as good as it could have been under the circumstances. But with the pain still under watch, I had to stay another night.
It was good to see Tyler and the night time staff again.
Wednesday - Discharge
The next morning, things went kind of slow. I was just ready to leave and begin the next stage of recovery. I was surprised to have a physical therapy session prior to leaving. It seemed kind of early. Luckily they were nice and didn't torture me too much. The site of the incision was cleaned and redressed, a few feeble strength sets were practiced along with some stretching and ice therapy, and then the PT did a really good job of gradually flexing the knee. We got to 83 degrees, which he was satisfied with, but being so close to 90 I just had to give it a shot! We nailed it and then hit the road with a car full of a CPM machine, walker, crutches, portable infernal handicapped toilet thing, all our luggage, and one wrecked immobile patient with a bad attitude. But we were on the road! And now, there's nothing left to do but heal!
A little PT before hitting the road bound for home. I only had one brief session, but I was very impressed with the PT crew at Andrews.
Wednesday - Post-Op
I made it through the night okay though there were rough patches, and I was still hitting that pain pump button like Ken Jennings going for the Jeopardy one-day earnings record. But I hadn't peed yet and I knew two things about that: (1), I really did need to pee, which was good, and (2), I'm prone to stage freight in uncomfortable pee situations (there's a whole 'nother blog post on that buried somewhere in my blog) and, this time, if I didn't perform the consequences were going to involve humiliation, a man touching my wiener, and feeling violated. And this was bad.
Tyler now took on the role of Chief of the Pee Police, as me having a go was obviously priority number 1 (Sure, to them, but pain meds were still first and foremost to me!), and Angie was somehow deputized into their posse. If I didn't pee, they were coming for me. I grabbed my pee bottle, had them turn the faucet on, and kicked them all out of the room. After an intense struggle I got 100 mL. I was so proud. The Pee Police were not. They moved me to the edge of the bed where gravity might become a bigger player, left the room and I tried again. But it was like Greenville Utilities had shut off my plumbing. They came in and said the catheter word and I pleaded with them to stand me up and let me have another try. Now standing using the aid of two male nurses and in serious pain as everything flushed down my leg, Angie went under my skirt and turned the tap on. My tale must have been between my legs and in the way though. Nothing was coming out of me but dry, dusty humiliation. It was my humility vs the posse's frustration. I asked for one more shot at it sitting down and managed another 100 mL but knew it was futile.
Tyler ran an in-and-out catheter up my wiener and drew out a 600 mL bag of pee. It really wasn't painful at all. And I felt closer to Tyler than with some of my best friends after that awkward moment. I got back prone in my bed wondering if I should send the nice man flowers or a box of chocolate, and he introduced me to the day shift nurse that would take his place for the next 12 hrs. I think I slept most of Wednesday morning.
First steps with a walker, and of course, no load-bearing on the new knee. I love those post-surgery socks they give you at the hospital.
It was clear I wasn't going home today. The pain was not yet under control and I was still woozy, probably cuz I was soaking up all the nausea from the meds and leaving the painkiller stuff still in the drug. I know, just humor me.
I woke up around lunch to some food I was not up to eating. And the level of pain was a 6/10. The nurse went to get an approval to boost the pain pump meds to every 8 minutes. I laid there for 3 hrs mashing the Jeopardy button every minute, willing it to release its precious narcotics, all the while though hearing that 4 beep tune that meant' "No drugs for you! Wait longer!" Pain was now at a 9/10 and I couldn't stand it any longer. I called the nurse at the desk and begged her to give me something and Angie was now outside the room in a panic trying to get anyone to come in and help. My nurse came in finally and said she still hadn't gotten word from a doctor to approve upping my meds. I was now looking for anything.....morphine, whatever, just something to ease the pain even temporarily so we could figure out a new pain med protocol. She asked, "Well, what do you want me to do?" And if it weren't for all the pain and the fact that she seemed to be the only way to get me out of it, I would have unleashed a fury on her. Turns out I didn't have to cuz Angie was there and she's always willing to dig deep and let someone have a piece of her mind. Another nurse came in, or maybe she was PT, because she went straight to my leg brace and discovered one of the latches was too tight and was digging into my incision. Within 15 minutes of loosening that I began to feel a little bit better but not near good enough. The head nurse also came in and suggested switching to oral meds. Once we did so, all was good again. But it was a dicey 4 hrs. Angie and I made up with the nurse that was assigned to me and life was as good as it could have been under the circumstances. But with the pain still under watch, I had to stay another night.
It was good to see Tyler and the night time staff again.
Wednesday - Discharge
The next morning, things went kind of slow. I was just ready to leave and begin the next stage of recovery. I was surprised to have a physical therapy session prior to leaving. It seemed kind of early. Luckily they were nice and didn't torture me too much. The site of the incision was cleaned and redressed, a few feeble strength sets were practiced along with some stretching and ice therapy, and then the PT did a really good job of gradually flexing the knee. We got to 83 degrees, which he was satisfied with, but being so close to 90 I just had to give it a shot! We nailed it and then hit the road with a car full of a CPM machine, walker, crutches, portable infernal handicapped toilet thing, all our luggage, and one wrecked immobile patient with a bad attitude. But we were on the road! And now, there's nothing left to do but heal!
A little PT before hitting the road bound for home. I only had one brief session, but I was very impressed with the PT crew at Andrews.
Unfortunately, I won't be able to compete this year.....
This will probably leave a mark for a while.......
Home sweet home, and it's deja vu all over again!
I'll finish with one more Far Side cartoon......because all setbacks are relative!
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ReplyDeleteGood to see you're doing well Bruce, and glad you're keeping us updated through your blog. - Chris Smith
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