Archive
Slow Going
It’s not quite 2 weeks since surgery, but I thought it was time for an update. Things have been going as expected … slowly.
Tuesday morning we saw the surgeon (a day earlier than scheduled due to the ER visits) to get evaluated. Everything is going really well with my knee. Just getting from the car to the doctor’s office was the worst part of the trip – I had to go probably 300-400 feet on my crutches. That’s a long way to go for someone in pain.
They took all of the staples that were holding together the incision – about 20 of them. This was a bit uncomfortable because a few had started to have my skin grow over them, but it wasn’t too bad. Most I didn’t feel, and the ones that were the worst just felt like someone was pinching you really hard.
After the staples were out I had a few X-rays taken so the doc could see what’s up. It was weird being outside of the brace and standing up (with my crutches). Definitely unnerving and scary. But it went well and everything is healing inside just fine. In fact I’ve been very surprised with how well my knee is doing after surgery. I think if I didn’t have the hematoma causing all the pain and swelling in my lower leg that I’d be absolutely fantastic, and probably back at work.
Unfortunately, I DO have that damn hematoma, and it’s been the source of 80% of my pain and issues. As long as I’m sitting with my leg up I’m okay. But as soon as I have to get my foot below my hip-level to stand or sit in the car or whatever, I can literally feel my lower leg swell and it turns into a huge source of pain and discomfort. The doc said he wasn’t too worried about the hematoma, and that physical therapy (massage, stretching, etc.) will help alleviate that. That being said, it’s going to add 2-3 weeks onto my recovery.
Because of this extended recovery period it’s going to be a lot longer than expected for me to become independent (I can’t really move without help). My wife Alicea has been absolutely awesome, but I know she’s had to make a lot of sacrifices for her work and personal time, plus take care of our daughter. Thankfully my folks are going to be able to come out and stay with us and help out. They should be here middle of next week (they have a trip to Myrtle Beach this week). It will be great to see them and have the extra help around the house. Shhh – don’t tell Kaitlyn. 🙂
I had hoped to be working from home a lot this week, but that didn’t materialize. My team has been reluctant to task me up with anything, and frankly I’ve been too doped up to be really useful anyway. I did get a chance to start working through the hundreds of emails that I got and started to make some small contributions though. Maybe this next week will be better.
Friday (yesterday) was a long day. It seemed like my pain was worse than it had been and the frustration of my situation really bore down on me. I missed a dose of pain meds overnight and that just made everything worse. Mentally it was a very hard day for me and I broke down before Alicea had to go to work. In the evening me leg was super-itchy and we decided to do some brace-off time to let things air out. Alicea also gave my leg a massage and put some lotion on to help the dry skin. In hind sight we probably should be doing that more often to help with the skin and itchiness.
By the time Friday night rolled around we decided to try to get me upstairs. After 11 nights (and 12 days) on the couch I REALLY wanted to lay down in a real bed. The problem is that our bedrooms are all upstairs and our stairs have a few steps that are very shallow (tough to maneuver on crutches). We figured out a solution, though. I sat on my rear at the bottom of the stairs and Alicea held my bad leg up. I used my arms to lift me up to the next step up, sat, moved up, sat, etc. We had to stop a few times because I got so tired, but we finally made it. Then I had to stand up, but couldn’t figure out how. I ended up just scooting over to the bed and using the bed frame to get me up. Not pretty, but effective!
Lying down for the first time in the bed (we have a Tempurpedic mattress) was like being in heaven. I even got to cuddle with my beautiful bride for a little bit. Wow, had I missed her. She’s been so busy and I’ve been in so much pain and out of it that we really haven’t had too many chances to talk or have some “us” time for the past couple weeks. It was great.
In the morning we figured out how to get me into the tub (we got a shower bench for me to use) and I took a shower. Ahhhhhhhhhh.
That’s about all there is for now. Physical therapy starts on Tuesday morning and my parents fly in from North Carolina on Wednesday evening.
Week 1: The Expected and the Unexpected
It’s been just about a week since I had my patellar realignment surgery on Monday 1/11/2010. I was hoping to update more often, but I’ve been “busy” with a few things. But I’ll start from the beginning…
The surgery actually went very well and as-expected. Well, that’s not true, there was something unexpected – the anesthesiologist offered me a nerve block in my left leg in addition to everything else. This has never been an option I’ve known about in my previous procedures, and let me tell you: IT’S FRIGGIN AWESOME! Essentially right before they knock you out they put a nerve block into your hip through an artery (either near the groin or your butt – or in my case it ended up being both). It doesn’t really hurt at all, but what it does for you is gives you about 12-24 hours of ZERO feeling in your leg. No pain, and the first day is always the worst! After we learned of this option it made sense why this surgery is now outpatient, where as in 2001 I stayed 1 or 2 nights.
The weird thing with the nerve block is that you have absolutely NO control over your leg for about a day. It’s like a dead appendage down there. But it doesn’t really hurt, so it’s well worth the trouble.
Getting home I realized I forgot to do something – practice with my crutches going up and down the few steps to get from the garage to the house. Oops. If it’s been a while since you’ve been on crutches get some practice time in before you go to surgery. Also make sure to set up where you will be when you get home. I’ve been on the couch for a week now, but we’ve made it pretty comfortable.
Monday night went pretty well. I didn’t know when the block would wear off so I made sure to keep up with my pain medications, but only at the low-end dosage. I woke up about the time for a medicine dose and was very sweaty. I had my wife take my temp and it was 100.5. I usually run colder than normal, but a minor fever is expected after surgery. 102F fever is the red line for when to call the doc. I also started noticing some discomfort at the bottom of my calf on my left/surgery leg, but nothing major. I figured it was just how my leg was propped up so we adjusted some pillows.
Alicea took Kaitlyn to daycare on Monday morning and while she was gone I was able to get myself to the bathroom without too much trouble – great! My calf was still hurting though – bummer! The block wore off sometime overnight so I was totally on my Percocet for pain management now, but I was keeping up. I slept a lot during the day from the pain meds, etc. but every time I woke up I was sweating. My temp got up to 101.8. Hmmm – that’s not good. Also my calf was starting to be more painful than my knee. HUH? We did some looking online and started to match some symptoms up with a possible blood clot in my leg. Pain in my calf when I moved my foot up/down, massive swelling of the calf and foot and toes, and my calf was VERY painful to the touch.
We talked to the surgeon’s nurse, a 24 hour nurse line, and a few other resources and decided that we needed to go to the ER and get this checked out. The last thing I wanted was a blood clot to break loose in the middle of the night when I was asleep and do some nasty stuff. On the way to the Swedish ER in Issaquah I started having a bit of pressure (not pain) in my right chest; like someone had their thumb on the right side of my sternum.
The Swedish ER in Issaquah is absolutely fantastic. If you’re in the area and need an ER I highly recommend you go there. Staff is very professional, knowledgable, and super friendly. The ER doc said he was pretty sure I had a clot in my leg as I had all the telltale signs and pain. They took off my leg brace and wraps and everything looked normal with my incision site – though there had been significant “seeping” of blood into the gauze pads, which is expected. With the chest discomfort they decided to do a CT Scan with some special radioactive dye in my veins to find any clots. But none were found. The ER doc said that was about 98.5% definitive that there was no clot, and that the best thing to do was wait and see what happens. They put humpty dumpty back together again and said I should see my surgeon or primary care doc again at the end of the week.
Wednesday and Thursday were more of the same … lots of pain in my calf and not too much in my knee. We got a urinal from the ER on Tuesday so I didn’t have to get up to go #1 any more. This little piece of plastic is a life saver. My calf was pretty bad for the pain so I was on max Percocet, to a mostly positive impact on pain. We also called the surgeon and he said seeing my primary care on Friday was fine, but to keep him posted. Our scheduled follow-up with him isn’t until this coming Wednesday, 10 days out from surgery.
At my doc’s office (www.villagefamilyclinic.com – Kristina is absolutely an incredible care giver for my family) we unwrapped everything again and found lots more seeping. I’m not sure if that much on top of what was there at the ER 3 days before was expected, but there were definitely a few spots still seeping a little blood between the staples.
Kristina didn’t think it was a clot anymore since she found my whole leg was swollen and hot, not just my lower extremities. She called and talked with my surgeon and they decided to put me on a high-powered antibiotic thinking that perhaps there’s some infection deep within the joint system (the incision looks totally fine). She also wanted me to go on a more powerful pain medication and get an ultrasound of my leg to completely rule out a clot.
Due to scheduling and resource availability we ended up having to go the pharmacy, then get Kaitlyn from daycare, and then roll to Bellevue’s Overlake Hospital for an outpatient ultrasound. The timing was bad and I missed a dosage of pain meds. Unfortunately my leg “went downhill fast” with pain and we ended up going to the ER at Overlake first. They were able to get my pain under control after an hour or two and wheeled me back for the ultrasound.
The ultrasound on my leg was not able to show any blood clots – hurray! But what they did find was a large hematoma – a pool of blood – between the muscle layers in my calf. This is likely from internal bleeding after the surgery that made it’s way there via pressure from swelling. Another possible cause is a tear in the calf. In fact I talked with the on-call doc from my surgeon’s group today and he said that we’re effectively battling two different injuries now: knee and calf.
There’s not much to do about the hematoma over the weekend. I’ll be seeing my surgeon or someone from his group most likely tomorrow. I’ll know more in the morning when I can talk with my doc’s nurse to see what his schedule is like.
The bottom line is that I’m in some minor-ish pain (2-4 out of 10) from my knee and calf as long as I’m lying down with my leg propped up. If I need to get off the couch as soon as my leg dips below my hip level it feels like someone has lit off a pain grenade in my whole leg; definitely a 10 on the pain scale.
But these issues are not surprising for me because this was my 4th surgery on my left knee. The more you mess with the joint the more issues surgery can cause. If this was my first surgery and just having a patellar realignment I would be doing great, most likely independent for movement within the house and maybe brave enough to go upstairs to sleep in a real bed. I’d definitely be ready to start working (from home) in the morning to feel like I’m actually still involved in the world out there.
Instead, I’m not sure when I’m going to be okay to work from home. I’m hoping it will be sometime later this week, but time will tell. Until then I’m going to be stuck on the couch taking Dilaudid 4-8mg every 6 hours for pain, 800mg of ibuprofen every 8 hours for swelling, and a horse pill of antibiotics every 12 hours.
I’ll try to write another update in a few days. In the mean time feel free to follow me on Twitter – @nanovak.
Here we go again
In about 14 hours I’ll be wheeled back into the operating room for my fourth surgery on my left knee. Unfortunately this really is a case of “been there, done that.” How did we get to this situation? I’m glad you asked…
Back in August of 1992 I was playing a friendly game of volleyball on a sand court at my mom’s company picnic in Charlotte, NC. The CEO gave me a beautiful set from the back line which I proceeded to spike into somebody’s face on the other side of the net, scoring the point in the process. And really, that’s the important part of the story – I won the point.
Unfortunately on the way back down to the ground my femur decided to explode at the knee joint. A week later I was having my first major surgery on my knee to pin everything back together and try to reattach all the tendons and ligaments that were damaged in the trauma. Three months on crutches and 6+ months of physical therapy humpty dumpty was back together again.
Everything was okay for about 8 years and a move to Seattle, but then I started having my knee dislocate on rare occasions with no major impact or event. I would be standing and talking to someone in the office, turn to leave and wham-o. At first it was once or twice a year … then once a quarter … then monthly, weekly, … you get the picture.
So in 2001 I had my second major surgery – a patellar realignment. Essentially my kneecap was not in the right place so the doc went in and cut the patellar tendon off the bone on my lower leg and reattached it in a better spot (about 1.5cm to the inside) with a couple screws. They also shortened a few tendons to try to pull it further into the right spot. Another 5 months later (my last physical therapy appointment was the morning of 9/11) I was good to go and my knee was stable.
Over the next 5 years my knee was mostly okay, but by 2006 there was a lot of grinding a swelling in the joint causing some pain. So I had arthroscopic surgery to “clean out” the built up scar tissue and smooth out the surfaces in a knee that was already starting to see some moderate arthritis buildup. Unfortunately when all was said and done this procedure really didn’t seem to make much difference for the quality of my knee pain and comfort. What’s worse is we discovered that the tendons that were supposed to be pulling my kneecap into the right place had “released” that adjustment.
Fast forward to a month ago and my knee was telling me that it was time to go see a doc again. I was avoiding putting our daughter to bed at night because I didn’t want to walk up the stairs in pain. So I went to a new doc from the past 2 procedures (thanks to an insurance change, and I felt it was time for another opinion anyway) and we’ve decided that we need to do another patellar realignment. My kneecap is nowhere near in the right place and the innards of my knee have undergone “significant arthritic change.”
So tomorrow morning I’m having surgery … again. My kneecap will essentially be disconnected and then screwed back in at a different spot and I’ll have a ton of work done inside the joint to clean things up and adjust the tendons. I’m looking at a month or so in a big leg brace and on crutches, then months of PT.
My hope is to blog about this experience so other folks know what this is like. I’ve done a lot of looking online and there are not a lot of good resources (I’ve found) on what a patient should expect from this ordeal. Should be fun – for you, not for me.
I’ll start out with a picture … we’ll call this one “Before”. I’ll try to post “After” tomorrow. You can see how much swelling is in my knee – and I’ve been sitting on my recliner with my leg in this position pretty much all day. The scar on the outside (left) of my knee is the original surgery from 1992. The one on top is from 2001. The theory is that the doc will use the 2001 line for another incision tomorrow – have to keep my legs pretty you know.
Update 1/17/2010 – here’s the report from 1 week later: https://nathan.thenovaks.net/2010/01/17/week-1-the-expected-and-the-unexpected/
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