Friday, January 30, 2015

Lenny and Arnie: Knee surgery part 2

One of the things I kept wondering, as I laid on the gurney before each surgery is, "Why am I doing this? I can still walk..." But the deal is, it was starting to hurt real good most all the time and I was fast becoming bowlegged, as the interior parts of my knee rotted away with osteoarthritis. And the worse it gets, the less you walk or exercise, and the further you have to go with recovery, etc. etc. So at some point you gotta make a move. 

And of course, at this point, now that the surgery is all done, there's not that much point in revisiting the rationale. It's a done deal. Recovery is the thing now.

We upwrapped knee one, the left one, which I have named Lenny (le [ft]-knee) about two days out of surgery. Looks like a pretty clean job.

I wish I had had the wits to do a better documentation before the first surgery. But I didn't. Anyhow, here is a shot of Lenny (post surgery, and Arnie (R-knee) pre-surgery. You can see why I am doing both. If left with one crooked, shorter leg, my back would soon be toast.

There's not a lot to talk about during re-hab. Boring exercises that hurt like hell. But hey, look at that flex.

Two weeks later to the day I was back on the gurney for round two. And an hour or two later, back in the waah-bulance headed home.

So now I get to do electrified leg lifts, with a zippy, zappy muscle re-education gizmo. Turns out my quadriceps forgot a lot of what they used to think was normal. A little shock therapy does wonders in reminding them how it all works.

  And the slow painful one: extended pole dancing for range of motion:

But nearly every day when I measure the flex with my goniometer (go-knee-ometer) I get rewarded with concrete signs of progress. Lenny broke 140 degrees yesterday. Amazing. Arnie is already in the mid-120s. 

And some rubber band stretches.

A bit of biking. Ow.

And the post-stretch icing. My favorite part.

Two days out from the second surgery the comparison is re-assuring. Lenny is looking pretty clean, healed, and unswolen. Arnie is a bit pissy but has a good path laid out ahead of him. 

And I ain't bowlegged no mo.

So now it is another month of the dance between exercise and recovery, stretching my limits and mitigating the swelling, pain and oxycodone, pushing it and backing off. Got say, it really does hurt a lot. But progress is so alarmingly visible each day that I remain pretty damned enthusiastic about the whole process. Unless you catch me at a bad moment.

Friday, January 16, 2015

Eddying out for structural repairs

For the last decade my knees have been sending me unpleasant nastygrams with increasing frequency as they slowly morphed into an old cowboy's bandy-legged profile. It seems the interior landing of both knees have been succumbing to a lifetime of playing hard, coupled with a pesky thing called osteoarthritis, which my parents gave me as a birthday present. The net result of all this is that my knees hurt pretty much full time, although sometimes even moreso.

But I just happened to stumble along at the right time. A fairly recent technology has come of age specifically for hapless victims like myself. It is a robotic surgery called MakoPlasty, and it replaces only the bits that have become defective, while realigning my anatomy to a straight-legged human. My old college pal Day tried it out two years ago and his enthusiasm sent me to investigate further. We tracked down a highly recommended surgeon down in Phoenix, Dr. Tarlow, and his robot Rio. The doc said I was a poster boy for this surgery. So I waited for the insurance calendar to begin a new deductible year and set sail for Phoenix.

Last week I got to go for a ride in the space age cat scan machine. It whirs and hisses as you slide in and out of the tube of power. They tell me it made a very accurate 3D map of my legs from hip to ankle. This data gets fed to Rio the Robot.

On Monday morning they gave me a handsome buttless gown, stuck some things in me and told me to say Good Night Brad.

Then they did some stuff. Here are some pictures of what they tell me happened next. First off, Dr. Tarlow and his friend Rio showed up. 

Then they screwed some antennae into my upper and lower leg and tuned them into Rio, so he (she?) would know very, very precisely where my anatomy was hovering in the space-time continuum. Then they sliced open my knee and, with a little grinder attached to Rio's arm, ground out the funky part of my joint and made an awesomely precise landing for some chunks of metal.

Here is a little four-part diagram. Upper left: My former left knee and current right knee. Meniscus worn out, bones sad and angry. Upper right: what would happen in a total knee replacement. We are not going there today. Lower left: Rio and Dr. Tarlow engraving my knee joint. Lower right: new metal and plastic gizmo epoxied in.

And it ends up something like this:

As recently as two years ago when Day got his MakoPlasty, it involved a hospital stay. But now it can be done as an outpatient procedure in a strip-mall surgi-center. They are now doing a smaller incision, have a lot more practice at it, but one of the main advances is an incredibly precise nerve-block, done with a long scary needle and a jazzed-up ultrasound outfit. Here is what they were looking at. I can't make head nor tail of it. But it enables them to turn off all sensation from knee to lower calf while leaving the entire leg, ankle, and foot fully operational.

As a result, when I woke up--in what seemed less than a nanosecond after watching them do the nerve block--I could get up and walk to the potty and pee. Fully weight bearing on my new magic knee. Without pain. With an audience of three.

Then it was time to get dressed and blast on back to Flagstaff. Lora is speeding us north in our slipshod waaaah-bulance.:

One of my great concerns was how do I, with a freshly rebuilt knee, get from my driveway up the long, muddy switchbacks, to my house? Wheelbarrow? Furniture dolly? I was over-thinking it. Get out of the car and walk up to the long, muddy switchbacks to my house.

And walk up the stairs, sit in my chair, and play my ukulele. I find this more than mind-boggling. At 7:30 a.m. I was lying on a gurney in the pre-op room in Phoenix, wondering if the surgery would happen soon. At 1p.m., 5-1/2 hours later, I was 135 miles north, sitting in my living room, able to walk around, with a partial knee replacement.

That was four days ago. The rest is not very exciting. It took the nerve block more than three days to fully subside, so I missed a lot of the quality pain I paid for and had every right to expect. A few days of mild discomfort, a few days that I could call minor pain. Lots of exercises and stretches, lots of friends being astonishingly kind to me, and a few walks around the house, down the street, and about the boatshop.

Physical Therapy starts in three days, staples out two days after that, and five days after that: a new right knee to match. Woohoo!

Gigantic thanks to my dear friends Lora (whose RN skills and kind words and actions  were invaluable) and Day (who came down from Utah to help guide me through this wonderland). I owe you big.

Postscript: Ow. On day five the nerve block finally wore off and I found out just how irritated my knee was about all this. Turns out it is hard to follow the "let-pain-be-your-guide" activity plan when you can't feel the pain. I think I overdid it. Days five and six were pretty painful. Today is day seven and I am on an oxycodone holiday and doing my exercises a lot more gingerly. I think I'll be back on track here pretty quick.

Saturday, January 10, 2015

Down Und Oars

My fascination with oar-making got another infusion in New Zealand last fall. We made a short stop, on my way to build dories, at the Gull oar factory in Palmerston North. Gull oars are known for being are light, straight, and affordable--three things that are hard to find in a wood oar.  We met Bruce Woodfield (on the right) who runs the company and carved his first oar by hand back in 1967. At that time they were making ladders, cabinetry, and some small wood boats, and needed to make oars for the boats. Bruce soon began devising the machinery to make them en masse.

Peter (on the left), who had been running the machinery for about three decades, walked us through the factory. The first giant gizmo takes a piece of square stock and rounds in into a giant dowel. Really fast.

They have a wide array of cutters, so they can make just about any size shaft. Sadly (for me) this precludes the possibility of making tapered-shaft oars, which I have an addiction to. Luckily for Gull, this is not a universal malady among oarsmen.

This gizmo makes the blades out of flat boards, onto which it cuts a perfect concave edge which fits perfectly against the dowel shaft.

Next, this giant monster of a machine grabs the blade parts, glues them onto the shaft, clamps them, and zaps them with a radio frequency that instantly cooks the glue. 

That gizmo then hands it off the the next gizmo that cuts the taper into the blades. 

 And drops it in the basket for Peter. It is a loud and very impressive process.


Finally the hand of man (Peter) takes it over to the giant drum sander and quickly smoothes the blade.

The oars are then dip-varnished and allowed to drip dry.

 After which they are pushed into the handle-cutter.

And there you have it. A really straight, light oar. Peter said that when everything is running properly, he can produce 600-700 oars a day. Which makes them affordable. That's even better than my shop.