Thursday, June 4, 2009

Surgery Goes Swimmingly, Pain Level Zero

Yesterday I had the ankle surgery at Bend Surgical Center. It went just swell. As I've written earlier, I've had plenty of orthopedic procedures done for broken bones:
  • Right ankle fracture, open reduction (which means that the doc cuts you open to try to get things to fit back together), 1980
  • Right hip fracture, open reduction, got a giant lag bolt in there, 1980
  • Left knee broken at top of tibia and bottom of femur -- "floating knee" it's called. First open reduction January 1980, didn't heal (no union), second open reduction August 1980, that one took, but it eventually wore out with bone-on-bone, so:
  • Left knee total knee replacement with titanium wonder knee, 1998.
Now this -- the old ankle finally wore out.

As mentioned in previous posts, I first saw a Dr. Holmboe who suggested an ankle fusion, or for a possible temporary fix, a cortisone injection, which I elected to take because Mrs Elliott and I had a vacation in Spain at the end of May. His plan for the ankle surgery was three night in the ho$pital, six weeks in a cast, then another six or so weeks crutching about with physical therapy (PT), while the ankle strengthened.

But his bedside manner sucked, and his staff wasn't real friendly. The ankle blew out seven days after the injection and I was in a wheelchair for our vacation. The pain was intense and needed to take more pain meds than was safe just to keep from slashing my wrists.

When we got back from Spain we saw another recommended ankle doctor, Dr. Askew, who totally blew us away with his helpful, interested, and open manner, his friendly (and good-looking) staff (even Mike, his nurse practitioner was good-looking and I'm not gay), and his plan: outpatient surgery, a "PainPump" box for five days t0 block pain from the femoral nerve (which carries most of the pain), my ankle fixed with a boot for six weeks to immobilize it, and then the usual crutching stuff with PT.

Hospital stays are super-expensive, outpatient surgery is much less expensive.

So we elected to get surgerized by Askew. It was a no-brainer.

As the title to this post says, it went just fine. Into the center at 6:30, the usual paperwork (releases, agreement to pay, etc.) to sign, stripped down to undies with an open-back gown totally eliminating any sense of status or control, IV plugged in and saline drip started, ankle prepped, chat with anesthesiologist, rolled into surgery at 7:40, more interesting drug pushed into drip . . . then I woke up in the recovery room, teeth chattering from cold and low blood pressure. Warm blankies were draped over me, there was pain, pain meds given, pain pump turned on, and within a half hour (I think), Mrs Elliott was helping me into the car and I was pain-free.

I've been totally pain-free since. This little pain pump really works, and I gotta say that after nearly four weeks of make-a-grown-man-cry ankle pain and massive amounts of pain meds, being pain-free and off heavy medication is a wonderful thing.

I've got long haul ahead of me, and I expect I'll grow bored writing about my healing as it becomes part of the daily routine. It will be a while before I'm out and about, a while before Jack can go back out on the town, but we work with the cards we are dealt. I can continue my work since I work out of the house.

Dr. Askew -- recommended.

[Gory details follow in layman terms. If you're the queasy type then you've read as far as you need to. Skip the next paragraph]

So what Askew and team did to fuse this ankle is go into it arthroscopically and rough up the edges and surfaces of the joint bones with a Dremel-like tool, and modify the bones as needed for a good fit with the ankle adjusted to where it's meant to go. Then they cut a chunk of bone out of my right knee -- one of the bony protrusions that don't really do anything for a living -- and grind it up in a food processor to make a nice paste filled with happy little bone cells just itching to grow into strong bone, then packed that paste into and around the joint. Then a couple of deck screws (square drive? Torx? I forgot to ask) were run down through my leg bone, one through the fibula and one through the tibia to affix the ankle bone to the leg bones. The combination of rough-up edges and eager little bone cells fools the body into thinking that I've got a fracture that needs healing and tells them to get to work. The screws keep things together so the bone union process has a chance to glue everything nice and tight. Such procedures work about 95% of the time. There's a 5% chance that the ends don't form a union -- that happened with my left knee in 1980. In that case, they'll zap the joint with electricity and use other magic methods to try to activate the growth process. But 95% is pretty good odds.

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