Nathan's Occasional Blog

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.