In a nutshell

I realized for the sake of this particular blog (and not the readers of the other blog who want to know more medical details), I could really pare things down for simplicity's sake. The surgery on Monday did six things:

1. rotated the top of my femur outwards

2. rotated the top of my tibia inwards

3. sliced off the top front of my tibia (where the kneecap tendon attaches) and moved it away from the body midline

4. reconnected the outside part of my kneecap to the outside portion of the quad muscle (via tendon grafting). Actually, functionally you can't attach it to the muscle because it will tear. The other side of the tendon graft was attached directly to the end of my femur. I think.

5. tightened (read: shrinkwrapped) the inner part of my quad muscle to strengthen it

6. cut open the fascia 2/3 of the way down my shin (fascia is like a sausage casing if the muscle bundle was the sausage)

Numbers 1 and 2 should have been done to begin with.

Numbers 3 and 4 were reversals of previous surgeries.

Number 5 was a repeat.

Number 6 should have been done at one point but wasn't (unfortunately at a steep cost).

Ready, set, go!

Well we're finally here, Mom and me, that is. Cross your fingers that everything goes as planned tomorrow so that I wake up to both my mom and Peleke at my bedside! I'll write more about getting here later. I'm sure I'll have all sorts of free time :p

So tomorrow is the big day! I'll get there at 6am and the surgery is scheduled for 8.

Yeah, I'm really nervous.

Just over ten hours of driving and arriving to temps of 87. Too wiped to walk, time to hit the sack...

Harumph.

I think the stress is really getting to me. I'm climbing the walls right now, but I don't want to keep popping advil and tylenol to do anything. Arg. And the dogs... I seriously dislike our dogs right now. I'm not sure if they're acting out because Peleke is gone and I'm stressed or if it's just my perception. Probably the latter.

As far as the surgery goes, I don't think there's much more I can do at this point. Making some meals to freeze for when we get back and getting the house in order. I find myself constantly thinking and worrying about it, and I have to keep reminding myself that I've already made my decision after researching it until my brain was oozing out my ears. Still. I'm under no illusion that it will be easy or even remotely pain-free. The thought of bending my whole leg within an hour or two of finishing surgery and then riding a stationary bike within the week makes me feel a little queasy.

It will be worth it. I'll be fine. This summer will be great. It will be worth it. I'll be fine. This summer will be great. It will be worth it. I'll be fine. This summer will be great.

ad nauseum.

Not what I expected

So I'm currently stretched out between two chairs in our back yard. Late morning is the perfect time to be back here because the sun isn't at its hottest, when its then thankfully hidden behind the mini forest we have beyond the fence. The little birds are chirping, the squirrels are doing their best to drive the dogs insane, and as usual, the birds of prey are soaring on the thermals above our neighborhood. Actually, maybe they're just vultures. Whatever kind of bird they are, they're pretty to watch flying overhead. Also, they're known within the neighborhood to swoop into yards and grab up the neighborhood snakes. Given the two cotton mouths we've killed in our yard this past year, it's just another reason why those big black birds circling overhead don't creep me out anymore :)

Anyway, what made me think to drag the computer out into this peaceful oasis and write is this: our elderly neighbors on the other side of the fence had been enjoying the peace as well and quietly murmuring until about five minutes ago when Michael Jackson's "Just beat it" came on loudly, clearly out of their sound system. Totally weird.

Neither here nor there

So we're back into a routine here... but not for long! I'll drop the beasts off on Saturday and start trucking over to Texas. I'm sure the trip there will be better than last week's trip back- really anything would be better than that crummy finish. I locked myself out at 1:30 in the morning after a ten and a half hour drive. I had to sleep in my car. In the driveway. In the 42 degree night. Now I know, it's not COLD compared to where most of you guys are, however, sleeping in your car when it's 42 degrees out is cold no matter how you cut it. Yes, it is.

Anyway, mostly just managing pain and taking care of the dogs at this point. I think I'm ready to go. Oh, and of course the day after I mention what a luddite I am, I went out and bought a smart phone. * sigh *

Hear me out, though. I got the GarminFone for the GPS (that doesn't require using a data package). Of course, you have to get a data package anyway with a smart phone, but beyond email, don't expect me to be tap-tap-tapping away on my phone. It still kind of scares me. I do like the ability to be an mp3 player, GPS, and camera/video, though!

Oh and completely unrelated to anything I've driveled on about is this: I am totally going to be the old woman who dies of aspiration pneumonia. In fact, I might be the young woman who dies from it. Seriously, I have a major drinking problem. I can't tell if it's related to my non-existant proprioception, lack of situational awareness (that yes, I'm causing as I lift my glass to my lips), or, I don't know, some pathophysiology. Whatever it is, I've aspirated Plax, water, and goldfish crackers in the past two weeks alone. Let the record state, Plax is awful to inhale.

Here fishy fishy!

So Beast One woke me up today barking by the bed. Beast two was jumping on me. It was 7:15am. No rest for the weary, I suppose. I feel much more rested, though, so all's well.

We went to the beach so that they could swim off some energy. It was fun:

Joey learned to "snorkel" when the little fish caught his attention. He did this for about 20 minutes nonstop!

Just as they were beginning to get tired, I saw both of them watching something out in the channel. At first I was concerned that Beast One was going to swim out to check it out, but in the end the ball won her attention. After watching another minute, I realized they were dolphins! There were four of them playing and swimming after the boats! Sadly I only have my little phone camera (and I like living in the phone stone age, thank you very much! No smart phones for me!):

They might be hard to see with these pictures, but I promise they are there :)

The waiting game

Still waiting for the authorization so I can do the pre-op stuff and go home...

*sigh*

As nurses, when somebody mentions the "q word," they are looked upon as having put a curse of the plague upon the unit. I think sometimes the "w word" is the patient's version of that. Heh, patient... wait....

What. You know it's funny.

Quick update

Ok, I'll call today another success, though admittedly I'm a little disappointment. I'd gotten myself all psyched up for surgery within the week because if I didn't, I'd probably wuss out. Then for completely valid logistical and practical reasons, today they settled the date for March 21st. Two weeks. The day Peleke gets home.

Arg. It wasn't an easy decision, but like Peleke said, there will never be a good time. If I wait for his next deployment (whenever that may be), I'd be as-is probably throughout the summer. If I get this done on the 21st, there's a good chance I'll actually be mobile and able to enjoy playing. I'm sad that it will extend our time apart by another week or so, though. We don't really want to burn his leave to come sit around in the sticks with me while I'm getting hacked apart, put back together, and recovering, but I sure would love to at least have him the day of the surgery plus another day or two, you know? Oh well. There's never really going to be an ideal time.

I learned a few more details today about the surgery that I won't bore you with, but a few things I will mention. First, when I asked how long I'd be under anesthesia, he said about six hours. That's a loooong time to be under, but I feel better knowing that he does epidurals so that the level of anesthesia doesn't have to be as deep (plus excellent pain management for the immediate post op period). I'll stay in the hospital two to three days before staying at the hotel for maybe a week after.

But man, oh man, when that epidural is out and I'm on oral pain management! Eesh. To his credit, Dr. Texas is nothing if not honest. And both he and Nurse Texas have reiterated that this is a very big surgery involving a lot of pain. It's not that they're stingy with the dope (in fact, his nurse told me some nurses think they use maybe a bit too much while in the hospital). Broken bones HURT. It's difficult to pin down that balance of pain management that allows meaningful rehab. The realistic expectation is to control the pain enough so that I can start the rigorous rehab program within hours of surgery. They call them "cannonball exercises." Aptly named, I suspect, because that's how you have to approach it- "break all my bones, rotate, plate, screw, and graft? No worries- watch me completely flex and straighten my whole leg while I'm practically still waking up from anesthesia!" Double eesh.

Monday

Ok, so I'll consider today a win. Dr. Texas's office made an obvious effort to fit me in and expedite required tests and contacted the necessary people in order to make sure this trip out is worthwhile. I really appreciate it and would thus far recommend him. A had a few more x-rays (eesh, I'm going to be glowing by the time I'm 60) and a helpful introduction to Dr. Texas and his staff.

As an aside, I get a little worried with each xray and CT scan as I get older (and it's not just being a radiation-phobe as a nurse). It adds up. Tests are helpful and sometimes essential, but it's still radiation. Radiation is not benign. So for whatever it's worth, please keep this in mind people. Always push the envelope to see if you can go by scans you already have and wear the heavy apron/thyroid cover. Yes, I know there are types of exposures higher than xrays in daily life, but CT scans are still quite high in radiation (anywhere from 30 to 440 times the radiation of a simple xray). Why would you bother to put on sunscreen if you don't bother to ask if you can reasonably pass on medical radiation?

But Dr. Texas has been good about minimizing exposure. About him- I like him! His personality is a particular kind that I struggle with. Not in a bad way, I just struggle with the interactions because they feel awkward and stilted on my part. It's one where you let him do his thing and talk while you keep your questions until he's done. Then he's great about addressing them. He's thorough, intelligent, and clearly dedicated to his patients. I'll take it. "It" being the four part surgery I mentioned in the previous post. It's always comforting when two people do separate exams and come to the same conclusion. Gotta say, it's a first for my knees.

So I think I'll find out tomorrow for sure, but it sounds like they'll probably straighten me out on Monday. Monday at the earliest, anyway. As long as the dogs aren't causing problems with anybody and I can keep costs to a minimum while I'm away, Peleke and I have agreed it's ok. Thank goodness for Southwest Airline's free ticket exchange- my mom doesn't have to come down and kill time with me (until I'm chopped all apart anyway)! So here's to hoping it's on Monday.

I wanted to travel down to see my sister, but the nurse put the kibosh on that since she's getting over the hump of one of those lovely bugs her students feel so compelled to share. The last thing I want is to have to cancel for a stupid virus. So for the next few days, I'll be barricaded in a room somewhere nearby slathered in alcohol sanitizer and drinking orange juice like nobody's business. Anybody got a wii and want to play Mario Kart with me online this week?

Unrelated, I'd like to put this out for people to see. Mercy Ships was doing a screening in Freetown, Sierra Leone (where they go through hundreds of people to pick out ones they can most likely help) when the crowd got out of control and stormed the gates of the stadium. It's heartbreaking because we wish we could help each and every person, but of course it's not possible. How humbling for hundreds of people to have such faith and trust in Mercy Ships that they were so desperate to get in. But how tragic that people were injured and one person even killed. It brings home the reality of their desperation. Please pray for the ship's crew and people of Sierra Leone.

Here we go

So I guess for the next little bit, this may turn into a bit of an update blog. If this pans out, I don't think I'll be up for much communication for a bit, so I'll update here as I can. I guess for the record and people who don't know, here's the scoop:

I had the four left knee surgeries (to say nothing of the right) after patellofemoral pain started when I was fourteen. The last was eight years ago and provided moderate relief but since November my whole leg has gone rapidly downhill (fibular dislocation/subluxation, kneecap subluxation, and pain. Everywhere.). Saw the guru doc of treatment for these things up in Michigan this past week. I like him a lot as a physician, which is why I'm willing to go with the freakish, barbaric-sounding surgery he proposed (though for the record, it's not an exceedingly rare procedure and I'm his norm).

However, he can't do it until April of two thousand twelve. Yeah, next year. I guess that's what happens when you're the top of your specialty and pushing seventy years old and choose to do surgery once a week. Gack. So I'm going with who he (and many other people) recommend in Texas. I called Dr. Texas upon arrival back home on Wednesday, hoping he could get me in within six months. Instead they said they could probably get me into surgery in six days.

So basic anatomy. Both your femur (thigh bone) and tibia (shin bone) naturally have some rotation. This allows your hips, knees, and ankles to work in alignment as your leg naturally swings out and in during the course of walking. It's not unusual or even considered abnormal for babies to be born with their bones all twisted excessively- they need to be able to flex in utero. For the most part they outgrow it by age four, but some of us don't. If you're really all that interested, there's a more detailed description here.

We "twisted" folks have been diagnosed with any number of bucket diagnoses, which means to say they don't really know what's causing the patellofemoral pain. My favorite diagnosis (I kid you not) is "miserable malalignment." I think it's particularly descriptive. But there are at least fifty-six variables identified as contributing to patellofemoral pain. Rotational deformities are common causes, though most people have multiple things wrong. You can read about femoral torsion and tibial torsion here.

Me, I have excessive femoral anteversion and external tibial torsion. Several procedures done in the previous surgeries inadvertently made the knee structurally worse (and therefore now unstable and painful). At the time, mostly it was a case of the orthopedic surgeons not widely understanding the problem, how to assess it, and obviously then how to fix it. In order to fix my leg now, it requires undoing those previous alterations and then doing what should have been done in the first place. Said plainly, the seven hour surgery proposed by Dr. Michigan has four major parts:

1. Femoral derotational osteotomy

2. Tibial derotational osteotomy

3. Tibial Tubercle Transfer (TTT) to undo the first one

4. Reverse lateral release (requiring a graft)

Ugg. We'll see what Dr. Texas says. I'm assuming he'll come to the same conclusion (at least, over the phone he said that sounds about right), but I won't know for certain until Monday. I also won't know until Monday for certain if he can do the surgery on Wednesday. Something about making sure the necessary hardware and possible donor tendon grafts are available.

Why yes, I am freaked out. More to come I'm sure.