St Croix River Road Ramblings

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Thursday, March 15, 2012

Russ gets a new knee

In the endless series of knee articles, here is one describing the surgery. If you like blood, gore and the smells of burning bone and flesh, you might enjoy this story.

A few weeks before the surgery, I had a swab test of my nose. It showed staph germs, so I was prescribed antibiotic salve to put in the nose twice a day for a week before the surgery. Infections are a worry with replacement joints that don’t get normal blood flow in them to clear up infections. Most noses are reservoirs for staph germs, waiting for the nose to let down its guard and enter the blood stream and make us sick. Careful nose picking –that removes the big goobers of coagulated germs but doesn’t cause bleeding is necessary to keep them under control during normal times. They had to be killed off before the surgery just in case.

The night before surgery I showered with special anti-bacterial soap; stopped eating in the evening and had another shower in the morning with the germicide. I had been eating a high fiber diet as suggested in preparation for possible constipation after the surgery.

I am leery of using anti-bacterial soap. The first line of defense of our bodies against all the dangers of the outside world are the vast colonies of bacteria living on our skin and in our orifices. We have adapted to them and they to us living in what biologists call a “symbiotic” relationship (a win-win situation). Get rid of them and their place might be taken by brand new more dangerous ones we aren’t able to cope with. As Margo has been away for several weeks down with her Dad after his bypass surgery, I prepared by not showering for a few weeks and not changing the sheets so after surgery I could come back home and repopulate my skin with my old friendly bacteria!

The day before surgery, I had a last visit with my surgeon. Mostly he wanted to make sure I didn’t have a cold or infection and a blood test to show my levels of everything were normal. ”It will be a complicated surgery, more like second knee replacement because of the damage you did to your knee two years ago in the fall. We may have to use a lower knee extension peg to hold it securely. It should turn out fine, but until we get in there, we won’t know for sure.” I think he was in his 30s, a nice friendly doctor who wanted to make sure I understood everything.

I called in Sunday night at 8:15 to get my Monday surgery report time—6;30 am. Scott drove me in and I hobbled to the Methodist hospital admissions desk. Many knee surgeries are done at St. Mary’s and some at Methodist, depends on the doctor. In the old days, Catholics picked St. Mary’s and Protestants chose Methodist. Now they are fully merged into Mayo and are both non-denominational. However, as a Lapsed Protestant, I felt more at home in Methodist.

After checking in, I was wheeled to a preparation room where I stripped and changed into the back snapping hospital gown and a robe. I watched a short video that emphasized falls are dangerous, so whatever you do, never try to get up or walk while you are in the hospital without calling a nurse to help. My clothes were bagged and a rolling bed and attendant picked me up and took me to the pre-surgery room.

An anesthesiologist came by and we discussed gas (full knockout) or spinal (awake but numb from below the waist). I chose spinal so I could give advice to the doctor; with my 25 years of working at Mayo I picked up some medical knowledge that I thought might be useful in a pinch. An IV port in my right hand was setup. I also took a pill; Celebrex that I think was for pain and an antibiotic.

Several other folks were lined up in beds awaiting surgery. Two were brand new knees, one was a 2nd replacement knee, one was a bone repair and one a hip. My surgeon stopped by and chatted and wrote his initials with a marker on the right thigh. Identification of the patient and where to cut is a very fussy process as hospitals have occasionally operated on the wrong limb. It comforted me that being awake during surgery, I could politely say “no doc, the other leg” if he started on the wrong one.

Every stop and every interaction with a nurse, doctor or other person during the whole stay was preceded by “Spell your last and first name; What is your date of birth” and a laser scan of my wrist band making sure I was the right patient. Hospitals still have problems with misidentification. I counted 372 times I spelled my name and gave my birth date “Hanson Russell 12/10/46” as they scanned the wrist ban and the medication bottle or bag to record it on the computer. Mayo is a completely electronic record place so everything including the x-rays are all on computers. (I think they only had to do a couple of the ctrl alt delete reboots during the surgery).

They stuck on some ECG (heart) electrodes, a finger oxygen monitor and something that tracked my breathing. I was surrounded by beeping machines—as a computer technical guy that made me feel comfortable that the machines were making sure I was doing well all of the time so I didn’t have to depend on nurses who might get to talking about their date Sunday night.

At about 9 am I was rolled into the surgery room where I shifted to the surgery table. The surgery room was brightly lit with lots of stainless steel and a whole group of hovering folks; the surgical team. On the wall were several large computer screens with different views of my knee. “Boy whoever that knee belongs to sure looks like he is in pain,” I commented to the group as I slid over to the operating table, getting a reward of laughter from the operators (I was the operatee).

First they had me roll on my side and stuck a needle in my back to give the spinal. Some “mental fogger” came through my IV as they extended my arms to side table wings and strapped them down. I thought I would get bothered being strapped down, but I was really mellow by that time, the pleasant fog obscuring everything else. When I said I couldn’t feel my legs anymore, they put a cloth vertical hanging screen over my chest so I couldn’t see my legs anymore.

On my end, the anesthesiologist stayed by me and we talked during much of the surgery. I told her what I did at Mayo in research and other stuff while below the screen, all sorts of sounds of electric saws, drills and pneumatic hammers were rattling away—sounded like a construction site. I wonder if they used DeWalt tools like I have at home.

The monitors beeped with each heart beat, the tone changing with the oxygen level indicating I should breathe more deeply. Many screens showed information as to my heart, oxygen and probably other things. The whole process was recorded so if I complained, they could replay the operation for the judge and jury.

The surgery was an 8 inch cut through skin and tissue down to the bone from a few inches above the knee all the way to a few inches below the knee, right on the front. Once in, they had to saw off the ends of the two big bones that make up the knee joint and remove the stuff in the knee joint. After getting two flat surfaces and reaming out the center of the bone, they glued and drove the new knee ends into each bone. There was no pain, but it felt like they were pounding with a hammer as hard as they could to drive the metal pegs into the middle of the bones. I think there were about 25 whacks with a 13 pound blacksmith hammer that shook me and the bed a great deal. I was fully aware of the sawing, drilling and hammering, amused that I knew what they were doing and could hear them talking, smell the flesh, blood and burning from the saw blade, but just floated along pleasantly through the whole thing.

Eventually, at about 11 am, they said “It’s all done. Looks great. No problems with it” and wheeled me into the recovery room for another two hours, still hooked up to monitoring computers.

As I had the spinal, I had to wait until my legs unthawed, with lots of measurements ongoing. Finally I was rolled to a nice private room on 9th floor with a large window overlooking the city, where for three days I was inconvenienced by blood suckers, probers and measurers while floating on oxycodone. It reminded me very much of the times I have been abducted by aliens who also treated me the same way.

Thursday, I am in less pain, getting around with crutches and doing pretty good. The worst thing is that right next to my recliner is a waste basket and then a tray table where I keep my drugs. It appears I bumped the table and rolled my 80 oxycoden pain killers into the garbage that Scott took out and burned in our burn barrel--so I am without them.

I am not really bothered as the Tylenol work just about as good without the mental buzz of oxycodone that irritates me--makes me feel sort of hyper rather than just my stodgy self. I think on the illegal drug market they would have sold for $5 each--so a real loss with 80 of them! I don't dare ask the doc or pharmacist for a refill or I would likely get on all sorts of police lists.

Feeling some pain, but walking around some too -- The River Road Crawler

We will continue with the hospital stay next time.