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.

1 comment: