Thursday, November 18, 2010

Technical stuff today

Now that I've babbled for a couple days about how great I'm doing, I'll go into a little detail about the knee, called a 'right total knee arthroplasty' on the discharge papers.

A good knee supposedly looks like this:

My knee prior to surgery is the one on the left, heavy on jagged edges and arthritis.

You may have heard the name DePuy lately on the news - they're being sued from all sides about an allegedly faulty hip replacement. (I keep meaning to look into my old records to see whose hip I received three years back, but . . .) DePuy is in the Johnson & Johnson family, so I think they are basically sound, and I'm not worried about the knee.

What I received is a Sigma Fixed Bearing Cruciate Retaining Cemented Knee System. As their literature says:

DePuy's Sigma Fixed Bearing Knee System is an excellent example of a proven design made even better by utilizing advanced materials. Based on the clinically successful P.F.C.® Total Knee System introduced in 1984, Sigma continues a history of innovation based on clinical evidence.

Available in posterior cruciate retaining or posterior stabilized femoral component designs, this knee system is designed to provide surgical solutions for a variety of clinical indications. Research into advanced materials and designs has resulted in XLK poly and highly polished Cobalt Chrome (CoCr) tibial tray. The moderately cross-linked, oxidatively stabilized polyethylene insert maintains material toughness, while providing excellent wear performance. The modular construct of CoCr Tray, along with its highly polished surface provides an environment that is more polyethylene-friendly than a rough titanium tray to minimize abrasion and increase long-term durability. Finally, the tray and insert have a secure fit with a locking mechanism, achieving two important goals: 1) decreased micromotion and 2) maintaining the system's modular flexibility.

Thus by optimizing the tray, the locking mechanism, and the polyethylene, Sigma Fixed Bearing Knee System delivers the solution that surgeons desire for their high demand patients. It provides the benefits of a two-piece tibial construct that approaches the performance of a one-piece design.

There is a very detailed video that shows the surgical process, but I very STRONGLY suggest you NOT watch the video unless you are immune to blood and stuff - it's very graphic! I found it fascinating and I surely do understand where a lot of the aches and pains come from, because the surgery includes power saws and drills and a lot of manipulation!

My doc told me she removed my ACL during the surgery (which surprised the physical therapist). I didn't know enough about it to ask any useful questions - all I know is that it's an almost career ending injury for a football player. ACL - anterior curciate ligament - holds the knee together. Any more than that, I had to read the link but it didn't help me understand why it was removed. Guess I'll have to ask next time I see her.

My latest x-ray looks like this. All those tiny little things going up and down the leg are the staples holding the incision together, and that gray teardrop shaped blog under the appliance is a pocket of glue.

and a side view.

What else? Let's see - I did call a pharmacist to check on the Gabapentin as relates to my Carbamazapine. I've been taking the Carbamazapine (Tegretol) for years for a mild seizure disorder. The Gabapentin (Neurontin) was prescribed to me for the severe nerve drama that goes on in my damaged right ankle when it's manipulated (I trip or bump it, or fall, etc, or it gets used to move my leg around when it's in surgery!!). It's the only drug I've ever received that has any effect on that very painful condition. And it's also used to control seizures, so I was concerned that I might be over-medicating myself. The pharmacist said it's rarely prescribed for seizures anymore, because it's so good for nerve damage, and that I needn't worry, unless I take huge doses of it. That works for me! Plus, I just read all the fine print again, and see that one of the claims it makes is that it might help with hot flashes, particularly in women who have been treated for breast cancer!!! Yeah!!

The other thing I get to do at home, along with all the other discharge meds, is stick a plunger in my belly every day. I'm getting Lovenox for two weeks post surgery as a blood thinner. It's a tiny (really don't even feel it) needle into the fat on my tummy (and I do have plenty of that!!). I even came home with one of those medical bio-hazard red Sharps boxes for needle disposal!

My only complaint is that the insurance wouldn't pay for Lovenox - I had to get the generic - no big deal, but in this case I truly believe there is a difference between the name drug and the generic. The Lovenox always went is sweet and easy - the Enoxaparin stings! (Reminds me of the numbing med, Lidocaine - good folks add bicarb to the Lidocaine so it doesn't sting so much.) Plus, it turns out I don't seem to give a very good shot - my belly is a mass of bruises. Oh well, I'm not taking pictures of that one for anyone!

Then there is the physical therapy - I've now been abused four times, and am doing very well. The therapist and I have had a little trouble communicating, but I think we now understand each other. I was trying to make him understand that I simply can't do some of the things he wants. I've walked and lived straight-legged because of my ankle and other knee for 35+ years, with no kneeling or squatting at all, so 'back to normal' for me is to walk straight-legged, not bending like a gymnast. Now he's trying to work on the flexibility of the knee itself now rather than using the entire leg to accomplish the same thing.

In the course of the last couple visits, I fell into a pretty nasty funk. The knee is healing incredibly well, I'm walking better than I have in a long time, but I'm feeling very down - a whole lot of things coming together all at once I guess.

Now that summer is over, I'm having to find more than the five tank tops I've lived in for the last 8 months to wear. And I'm not having much luck. The damned lymphedema sleeve makes wearing anything with sleeves next to impossible - the fabric rides up to my shoulder. Plus being boobless on the same side versus full on the other, makes clothes look awful. I'm been experimenting with the prosthesis, but it's uncomfortable as hell and uncooperative. So I'm spending a lot of time feeling downright ugly.

I suspect having two major surgeries and all kinds of drugs in my system doesn't help. But I'm trying to battle thru it. Having Lizzie here helps, and being surrounded by my incredible friends (though by phone and email from a long distance) is invaluable.

Thanksgiving means being grateful for my wonderful friends!

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